
Class. 
Book,. 



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Copyright N°, 



COPYRIGHT DEPOSW 



VETERINARY OBSTETRICS 



INCLUDING THE 



DISEASES OF BREEDING ANIMALS 



THE NEW-BORN 



By W. L. WILLIAMS 

Professor of Surgery and Obstetrics in the New York State Veterinary 
College at Cornell University 



PUBI,ISHED BY THE AUTHOR 

AT ITHACA, N. Y. 

1909 



e^ 



f^' 






COPYRIGHT BY 
WILLIAMS 
1909 



W 



PRESS OF 

ANDRUS & CHURCH 

ITHACA, N. Y. 



LIBRARY Of CONGRESS 
Two CoDies Received 

JUN 25 )BU3 

J Copyrieiit Entry 
CLASS 'A. A«6, H, 
CJOPY 8.' 



PREFACE. 



Whatever apology may be due the American veterinary pro- 
fession for the imperfections of this volume, the author does not 
deem it necessary to apologize for considering desirable a treat- 
ise upon Veterinary Obstetrics, and the diseases and accidents 
intimately associated therewith. 

In American veterinary colleges, and largely in the veterinary 
colleges of the world, obstetrics is the most poorly and ineffi- 
ciently taught of all the major subjects in the veterinary curri- 
culum. The available obstetric literature in the English language 
is very unsatisfactory. The author believes that the chief ques- 
tion affecting this treati.se is not the need for a comprehensive 
volume upon veterinary obstetrics and the closely related sub- 
jects, but the efficiency of the volume to partly supply that need. 

We have felt warranted in introducing features which are not 
usually included in treatises upon obstetrics. We have devoted 
a chapter to the " Accidents and Injuries of Coition." A yet 
greater space has been devoted to the " Infections of Coition", 
especially to the specific venereal infections. Still more em- 
phasis has been placed upon the subject of sterility. 

The writer desires to heartily express his sense of profound 
obligation to the various authors and publishers upon whose 
publications, with their kind permission, free draft has been 
made for illustrations and material for the text. It has been 
aimed, at the proper places, to give due credit for the source of 
the material used. 

Special mention is due to the authors and publishers of the 
treatises on Embryology by Bonnet, Heisler and Marshall ; the 
Obstetrics of St. Cyr and Violet, Harms, Franck, DeBruin, and 
Fleming ; the Teratology of Gurlt ; and the Handbook of Surgery 
and Obstetrics by Bayer and Frohner. 

The author is under specially deep obligations to Professor 
Doctor E. Hess, of the Berne Veterinary School, for his courtesy 



iv Preface 

in permitting the insertion in our text of his extensive and ad- 
mirable contribution relating to sterility in cows. 

With a keen sense of the many and serious imperfections, this 
volume is submitted to the veterinary profession of America, 
hoping that it may awaken new interest in the practice of 
obstetrics, and extend some aid to those veterinarians engaged 
in obstetric work. 

W. L. Williams. 
Cornell Universitj', 

June I, 1909. 



CONTENTS. 

PAGE 

INTRODUCTORY i 

OBSTETRIC ANATOMY 3 

A. The Accessory Organs of Reproduction 3 

The Pelvis 3 

B. The Generative Organs 11 

The Ovaries 11 

TheMiillerian Ducts ; the Oviducts, Uterus and Vagina 19 

OBSTETRIC PHYSIOLOGY 40 

Reproduction 40 

Ovulation 44 

Estrum 48 

Copulation 49 

THE DANGERS AND INFECTIONS OF COITION 50 

Physical Injuries 50 

Generai, Infections of Coition 64 

Contagious Cellulitis 68 

Specific Infections of Coition 73 

Dourine 73 

Genital Horse Pox 92 

Venereal Diseases of Cattle 95 

Vesicular Exanthem . 95 

Granular Venereal Disease (See also Appendix I page 1075) 97 

Venereal Disease of the Dog 104 

Venereal Disease of Sheep (See also Appendix II page iii4'l_ 108 

Venereal Disease of Rabbits no 

Venereal Diseases of Swine and Goats no 

Other Infections of Genitai< Organs in 

Bursattee of the Penis and Prepuce in 

Actinomycosis of the Genital Organs 113 

MENSTRUATION 114 

FERTILIZATION 115 

The Relation between Estrum, Ovulation, Fertilization and 

Menstruation 116 

STERILITY 119 

Sterility of the Male Animal 121 

Sterility of the Female 153 

Nostrums and Panacea against Sterility 272 

Artificial Impregnation 278 

EMBRYOLOGY 281 

Germinal Layers 284 

The Primitive Streak 285 

Formation of the Embryo. 286 

The Coelom or Body Cavity 287 

The Nervous System 288 



vi Contents 

Devei<opment OF THE Organs of Special Sense 296 

The Olfactory Organs 296 

The Eye 298 

The Ear 300 

Formation OF THE Digestive Apparatus 304 

The Lungs Jio 

The Teeth 3" 

The Liver 318 

The Pancreas 318 

The Circulatory System 319 

The Development of the Urino-Genital System 332 

The Wolffian Ducts 33^ 

The Kidneys, Ureters and Bladder 334 

The Reproductive Organs 335 

The Limbs 34i 

The Fetal Membranes 347 

The Vitelline, or Yolk Sac 347 

The Amnion 347 

The AUantois 353 

The Chorion 355 

The Placenta 35^ 

The Umbilic Cord 364 

TERATOLGY 3^7 

PREGNANCY OR GESTATION 369 

The Form of the Pregnant Uterus 375 

The Position of the Fetiis in Uterus 379 

Signs of Pregnancy 3S4 

The Duration of Pregnancy 395 

HYGIENE OF THE PREGNANT ANIMAL 404 

ANOMALIES IN FECUNDATION AND GESTATION 413 

Superfecundation 413 

Extra-Uterine Pregnancy 415 

DISEASES OF THE PREGNANT ANIMAL 421 

Osteomalacic 423 

Dropsy of the Amnion and AUantois 424 

Dropsy of the Uterus 430 

Paraplegia 431 

Amaurosis 435 

Rupture of Prepubian Tendon 436 

Hernia of the Uterus 445 

Rupture of the Gravid Uterus 447 

Ante-Partum Prolapse of the Vagina 449 

Metrorrhagia 457 

DISEASES OF THE FETUS AND ITS MEMBRANES 460 

Death of the Fetus 460 

Maceration or Putrid Decomposition of the Fetus 463 

ABORTION 466 

Sporadic or Accidental Abortion 467 



Contents vii 

Enzootic Abortion 473 

Infectious Abortion 474 

NORMAL PARTURITION 509 

ExPui^iON OF Fetal Membranbs, and Involution of the Uterus 529 

Presentations AND Positions OF THE Fetus 530 

Management OF Normal Parturition 538 

The Care of the Parturient Animal and of the New-Born 550 

DYSTOKIA 568 

EQUIPMENT FOR OBSTETRIC WORK 576 

Cords and Bands ;i76 

Halters 577 

Forceps 582 

Traction 5S6 

Repellers and Repulsion 595 

Instruments for Section 599 

General Observations upon the Construction of Obstetric 

Instruments 608 

Obstetric Outfits 6ii 

The Dress of the Operator 613 

Position AND Control OF the Patient 615 

The Prevention of Infection During Obstetric Operations 620 

The Examination of the Patient 623 

The General Handling of Dystokia 927 

OBSTETRIC OPERATIONS 631 

Mutations 631 

Forced Extraction 640 

Embryotomy 641 

Exercises in Mutations and Embryotomy 661 

Csesariau Section 663 

MATERNAL DYSTOKIA 673 

Inadequate Expulsive Powers 673 

Pelvic Constriction 674 

Rigidity or Spasm of Cervix Uteri 682 

Induration of Cervix Uteri 685 

Malignant and Other New-Growths of Genital Passages 690 

DYSTOKIA DUE TO DISPLACEMENTS OF UTERUS 692 

Hernia of Uterus 692 

Deviation of Uterus. 692 

Torsion of Uterus 693 

FETAL DYSTOKIA 714 

Development of the Fetus in an Abnormal Position in the Uterus 7 1 6 

Bicornual Pregnancy or Transverse Development of the Fetus 716 

Abnormalities in the Development, or Diseases of the Fetus__ 727 

Excess of Volume of the F'etus 727 

Hydrocephalus 736 

• Ascites and Hydrothorax 739 

Anasarca 740 

Cysts and Cystic Degeneration of Fetal Organs 740 



viii Co7ite7its 

Tumors OF the Fetus 741 

Anomalies and Diseases of the Fetal Membranes 742 

Aberrations and Anomalies in the Development of the Fetus. 744 

Campylorrhacliis 744 

Schistocormus Reflexus 744 

Contractions of Extremities 746 

Double and Triple Monstrosities 74S 

The Dystokia of Twins 752 

ABNORMAL PRESENTATIONS AND POSITIONS OF THE FETUS 753 

Dystokia IN THE Longitudinal Presentations 753 

Dystokia in the Tranverse Presentations 786 

PATHOLOGY OF THE PARTURIENT OR PUERPERAL STATE-— 791 

Pathology of the Placenta 791 

Retention of Fetal Envelops 791 

Wounds and Injuries to the Genital and Neighboring Organs. 812 

Post-Partum Hemorrliage 812 

Rupture of the Uterus and Vagina 814 

Rupture of theBladder 820 

Rupture of the Intestines 820 

Rupture of the Diaphragm 821 

Rupture of the Sacro-Sciatic Ligaments 821 

Prolapse of the Intestines through the Ruptured Walls of the 

Uterus or Vagina 821 

Prolapse of the Bladder through a Rupture in the Vagina. 822 

Uterine Prolapse 823 

Eversion of Vagina 84S 

Prolapse of the Rectum 854 

Eversion of the Bladder 855 

Rupture of the Perineum 857 

Vesico- Vaginal Fistula S63 

Hematoma of the Vulva 864 

Relaxation of the Pelvic Symphysis 866 

Contusion of the Lumbo-Sacral Nerves 866 

Contusion of the Gluteal Nerves 867 

Contusion of the Obturator Nerves 868 

PUERPERAL INFECTIONS 871 

Acute metritis 872 

Acute Endometritis in the Mare 874 

Acute Metro-Peritonitis in the Mare -877 

Acute Metritis and Metro- Peritonitis in the Cow 878 

Acute Metritis in the Smaller Animals 884 

Chronic Metritis, Pyometra 885 

Chronic Metritis in the Mare 885 

Chronic Metritis in the Cow 894 

Pyometra in the Bitch and Cat ,.. 895 

Uterine Abscess 896 

Vaginitis and Vulvitis 898 



Contents ix 

Cystitis 900 

Peri-Vaginal Abscesses 901 

Py.tsmic Infection 902 

Puerperal Septic.^jmia 905 

Puerperal Laminitis 907 

Puerperal Tetanus 909 

PUERPERAL ECLAMPTIC DISEASES 911 

Parturient Eclampsia in the Mare 914 

Parturient Paresis in the Cow . 920 

Puerperal Eclampsia in the Sow 936 

The Milk Disease of Sheep 937 

Puerperal Eclampsia in the Bitch 93S 

DISEASES OF THE MAMMARY GLANDS 939 

Mammitis iu the Cow 940 

Acute Mammitis 941 

Infectious Mammitis of Cows 965 

Exanthema of the IMder 960 

Tuberculosis of the Udder 968 

Actinomycosis of the Udder 972 

Mastitis in the Mare 973 

Mammary Strangles iu the Mare 973 

Botryomycosis of the Udder 974 

Infectious Gangrenous Mammitis of Ewes 976 

Infectious Agalactia iu Goats and Sheep 977 

Mastitis in Swine 97S 

Mammitis in the Bitch 978 

Edema of the Udder 979 

Tumors of the Mammae 981 

Hemorrhages in the Udder 983 

Milk Fistulse 985 

Milk Calculi 987 

Pendulous Udder 988 

Dermatitis of the Udder 988 

Furunculosis of the Udder 990 

Wounds of the Teats and Udder 991 

Warts on the Teats 992 

Stricture or Atresia of the Teats 993 

DISEASES OF THE NEW-BORN 1003 

Infections 01- the New-Born 1003 

Omphalo-Phlebitis 1005 

Tetanus Neonatorum 102 1 

Dysentery of the New-Born 1022 

Sporadic Dysentery of the New-Born 1022 

Infectious Diarrhea of Calves . 1028 

Septic Pleuro-Pneumouia of Calyes 1032 

Calf Septicjemia 1033 

Bacteritemia 1033 



X Contents 

Non-Infectious Diseases and Defects of the New-Born 1035 

Asphyxia 1035 

Umbilic Hemorrhage 1037 



Persisteut Urachus_ 



.1039 



Retention of the Meconium 1041 

Anatomical Defects OF the New-Born 1046 

Umbilic Hernia 1046 

Scrotal Hernia 1059 

Imperforate Anus 1064 

Imperforate Vulva 1064 

Atresia of Posterior Nares 1065 

Atresia of other Body Openings 1066 

Fissure of the Palate 1067 

Persistent Foramen Ovale ; 1068 

Tongue Tie 1069 

Hernia Cerebrii 1069 

Odontomes 1069 

Rupture of the Extensor Pedis Tendons in the Anterior Limbs 

OF THE NEW-BORN 1070 

APPENDIX I The Granular Venereal Disease of Cows 1075 

APPENDIX II The Venereal Disease of Sheep 1114 

Errata 11 14 

Alphabetic Index 11 15 



VETERINARY OBSTETRICS 



INTRODUCTORY 

Veterinary obstetrics, in its most restricted sense, is a consid- 
eration of the necessary or advisable oversight or aid during the 
act of parturition in domestic animals. Birth constitutes one of 
the most prominent epochs in mammalian existence, marking the 
boundary between intra-uterine or fetal development, in which 
the young animal is nourished and protected within the maternal 
body by the mother, and the extra-uterine life, when the young 
animal must assume more or less independence and responsibility, 
partly or wholly secure its own food and provide for its safety. 

The giving of birth to yonng is the culminating act of a series 
of complex and interesting phenomena, the perversion or inter- 
ruption of any one of which may lead to the defeat of reproduc- 
tion, and when the act has been completed and living offspring 
produced, there are still incidents immediately following", which 
are essentially dependent upon parturition and which may jeop- 
ardize the life or usefulness of either the mother or her young. 

The subject is one of intense scientific and economic impor- 
tance as it lies at the very foundation of livestock husbandry and 
largely determines the ultimate success or failure of this great 
industry. 

It is necessary to have a full comprehension of each corollary 
process in order that we may effectivel}^ grasp the significance of 
the phenomenon itself. Successful parturition occurs only when 
the prospective mother is normal in the structure and physiologic 
development of all her organs of reproduction and of others 
which may have an essential relation thereto ; and the fetus must 
undergo a normal development ere it can be born in a viable 
state. 

We consequently habitually include under veterinary obstet- 
rics all factors which necessarily precede and lead directly to par- 
turition and all immediate consequences of birth which aifect the 
health of either the mother or the young. In this wider signifi- 
cance veterinary obstetrics may be defined as the study of the 



2 Vetermary Obstetrics 

dangers and diseases occurring in the process of reproduction in 
domestic animals and our means for avoiding or overcoming them. 
Under this conception we necessarily include : 

1 . A study of the anatomy of all those organs having a vital 
relation to the act of reproduction either directly or indirectly : 
Obstetric Anatomy. 

2. A study of the physiologic functions of the reproductive 
organs, including such phenomena as sexual desire or estrum, 
ovulation, menstruation, copulation, fecundation, the origin and 
development of the fetus and the birth of the young : Obstetric 
Physiology. 

3. The pathology of breeding, including the accidents and dis- 
eases dependent upon coition or interfering with fecundation. 

4. Aberrations in the development of the embryo : Teratology . 

5. Accidents and diseases of the mother and fetus during 
pregnancy ; Pathology of Pregna7icy . 

6. Difficult birth : Dystocia. 

7. Accidents and diseases of the mother occurring as a sequence 
to parturition : Pathology of the Puerperal State. 

8. Diseases and accidents of the new-born acquired during 
intra-uterine life or referable to the exigencies of birth. 



OBSTETRIC ANATOMY 

Each organ or part of the body contributes directly or indi- 
rectly toward the function of reproduction, but, in many of them, 
the influence is so remote that their relationship to breeding does 
not require special consideration, while some organs or parts, de- 
signed primarily to serve other ends, incidentally perform impor- 
tant accessory offices in the act of birth, as in the case of the pel- 
vis, while other organs, like the ovaries, uterus, vagina, vulva and 
mammae are devoted exclusively to the procreation of the spe- 
cies and are designated reproductory or generative organs. 

A. The Accessory Organs of Reproduction. 
The Pelvis. 

The pelvis constitutes an accessory organ of generation of 
fundamental importance because the fetus must traverse its canal 
in the process of birth, and success or failure may be decided by 
the amplitude of the pelvic channel in relation to the size of the 
fetal body. 

It consists of a bony girdle forming the posterior body wall, 
into which extends the posterior prolongation of the peritoneal 
cavity, and the terminal portions of the digestive, urinary and 
generative systems. Our chief obstetric interest in the pelvis is 
in its internal face, constituting the walls of its cavity. 

The pelvis is composed of the sacrum and coxae or ossa inno- 
minata, with their ligaments, and the first two or three coccy- 
geal vertebrae may be regarded as participating somewhat in its 
formation as they constitute a part of the pelvic roof. 

The sacrum consists of a series of anchylosed sacral verte- 
brae, varying in number in the different species of domestic ani- 
mals ; in the horse and ruminants five, in the pig four, and in 
carnivora three. 

In sagitttal section it presents the form of a truncated cone 
with its base articulating anteriorly with the last lumbar verte- 
bra and its apex posteriorly with the first coccygeal bone, 

In cross section it is triangular, with its base inferior. The 
lateral surfaces offer roughened facets for articulation with the 
3 



4 Veterinary Obstetrics 

coxae. The inferior surface contributes to the formation of the 
pelvic roof, is concave from before to behind, essential!}- plane 
from side to side and shows transverse lines of demarcation be- 
tween the individual vertebrae in the form of ridges var}ang in 
prominence with species, age, breed and individual. It is alleged 
that the sacrum varies according to sex, the articular elevations 
being, it is claimed, less prominent in the female. We have not 
been able to verify this claim by the stud}' of specimens. 




Fig. I. Sagittal Section of the Pelvis of the Mare, 

SHOWING LuMBO-SACRAL NERVES. 

S, First sacral vertebra. L, Last lumbar vertebra. A, Last lumbar 
nerve, passing passing over lumbo-sacral eminence. E, Gluteal nerves. 
O, Obturator nerve entering foramen.- 



The spinal canal extends through the sacrum and is occu- 
pied by the terminal nerves of the spinal cord. The inferior sur- 
face of the bone shows a series of paired openings, through which 
the sacral nerves emerge to take a prominent part in the forma- 
tion of the lumbo-s&cral plexus. Most of these emerge in such a 



77;^? Pelvis 5 

manner as to render mechanical injury to them during parturi- 
tion ver}' improbable, while others, especially the anterior gluteal 
and obturator nerves from the' last lumbar pair. Fig. i , have to 
pass over a promontory marking the lumbo-sacral articulation at 
A, in such a manner that they may be, and not rarely are, 
crushed between the bony ridge and some unyielding part of the 
fetus during its passage through the pelvic canal. The ob- 
turator nerve may also be injured in a somewhat similar manner 
as it enters the obturator foramen, as shown in Fig. 140. (See 
Contusions of Lumbo-sacral Nerves. ) 

The two coxae or ossa innominata are elongated, flattened 
bones, widelj' expanded at each extremity, where they are com- 
posed chiefly of cancellated tissue, and constricted in the center, 
where they partake more of the structure of long bones. Above 
and anteriorlj' they are briefly separated from each other by the 
intervening sacrum, with which they articulate by means of an 
almost immovable joint ; behind or below they converge to form 
the pelvic floor, in which, on either side of the median line and 
about midway from behind to before, occur two large oval open- 
ings, the foramina ovale. They unite on the median line to con- 
stitute the ischio-pubic symphysis and, becoming anchjdosed early, 
serve, with the aid of the well-nigh immovable sacro-iliac articu- 
lation, to complete the pelvic girdle. Near the middle of each 
coxa, on the infero-external face, occurs the acetabulum or coty- 
loid cavity for articulation with the femur. 

Each coxa is composed of an ilium, ischium and pubis, which 
constitute separate bones during early fetal life, but become fused 
together prior to birth to constitute a single bone. 

The general direction of the ossa innominata is obliquely back- 
wards and downwards from the sacrum, the two coxae curving 
at first outwards and later inwards to unite on the median line 
and, with the sacrum, to complete the oval pelvic inlet. 

The ilium, the largest of the three, is flat and triangular in 
outline, its supero-external face being concave and occupied by 
the gluteal muscles, the infero-internal face being occupied largely 
by the articulation with the sacrum inwardly and bj' muscular 
insertions laterally. The postero-inferior angle of the bone is 
contracted and rounded to form the iliac shaft and ends by con- 
curring with the ischium and pubis in the formation of the ace- 
tabulum. The two ilia extend obliquely downwards and back- 



6 Veterinary Obstetrics 

wards from their sacral articulation, their inner borders being 
concave. They attain their greatest distance from each other 
soon after leaving the sacrum, near the great sciatic notch, at 
the point where the flattened anterior portion merges into the 
shaft, from whence they converge slightly as they approach the 
cotyloid cavities. The ilia form the majoi: portion of the lateral 
walls of the pelvic inlet. 

The ischium is an irregular triangular, flattened bone, con.sti- 
tuting the most posterior portion of the pelvis and concurring 
with the pubis in the formation of the pelvic floor. It occupies 
an almost horizontal position in the horse and most domestic ani- 
mals, but, in the cow, its posterior portion is directed upwards and 
backwards and compels the fetus, during its expulsion, to pass 
obliquely upwards and backwards, instead of horizontally back- 
wards. Anteriorly, it constitutes internally the posterior bound- 
ary of the foramen ovale and, externally, concurs in the formation 
of the acetabulum, where it articulates with the ilium and pubis ; 
on the median line it unites throughout its anterior part with the 
corresponding bone of the opposite side, constituting the pos- 
terior portion of the pelvic symphysis. 

The postero-external angles of the ischia are tuberous, consti- 
tuting the ischial tuberosities and between these is the receding 
angle known as the ischiatic notch, which depends largely' upon 
the extent of the tuberosities for its depth while its width is fixed 
by the degree of divergence of the two bones. 

This triangular notch varies greatly with species and individ- 
uals and some authors contend that it is wider arid more ample 
in the mare than in the horse. The latter contention is not well 
established and, if it exists, is not sufiiciently marked to consti- 
tute a means for differentiation between the sexes. 

The ischium is of little obstetric significance in domestic ani- 
mals, except possiblj' in the cow, where the notch may be ver}^ 
deep and narrow and the tuberosities, being very prominent and 
directed sharply upward toward the coccyx, tend to limit the di- 
mensions of the pelvic outlet and constitute a barrier to the pas- 
sage of the fetus. 

The pubis is a flattened bone placed transversely at the anter- 
ior border of the pelvis, articulating on the median line with the 
corresponding bone of the opposite side to constitute the floor of 
the pelvic inlet. It articulates posteriorly with the ischium and 



The Pelvis 7 

concurs with the ilium and ischium in the formation of the ace- 
tabulum. 

In the mare there frequently appears a sharp elevation on the 
median line at the anterior end of the symphisis pubis, surmount- 
ing the pubic brim and projecting upwards into the pelvic cavitj^ 
in a manner to endanger the integrity of the vaginal or uterine 
walls when impinged between this sharp elevation while the body 
of the fetus is passing over it under great pressure. See Fig. 1 13a. 

The relations between the pelvis and the spinal column are 
maintained by a series of ligaments and muscles. The sacro-iliac 
articulation is very rigid, the two bones being closely applied to 
each other by means of roughened surfaces and maintained b}' 
short and very strong inter-o,sseous ligaments. 

The integrity of the sacro-iliac articulation is further preserved 
behind by the sacro-sciatic ligament and in front by the pre- 
pubian tendon and the muscles contributing thereto. 

The great sacro-sciatic ligament arises from the transverse 
spinous ridge of the sacrum and, commencing immediately behind 
the sacro-iliac articulation, extends to the posterior extremity of 
that bone ; passing downwards, it is attached along the supero- 
external border of the ilium and ischium from the sacro-iliac 
articulation, backwards to the ischial tuberosity. The two liga- 
ments thus form wide aponeurotic sheets, which constitute the 
greater portions of the lateral pelvic walls and occupy all that 
area comprised between those portions of the sacrum and ilium 
posterior to the sacro-iliac articulation and the external bor- 
der of the ischium to the summit of the ischial tuberosity. 
This broad and powerful ligament serves to prevent the posterior 
portion of the pelvis or ischia from receding downwards from the 
sacrum and affords a strong and somewhat flexible and yielding 
wall to the pelvic cavity. It is suflEiciently extensible that, under 
the pressure of parturition, it yields enough to permit the con- 
stricted outlet to equal in dimensions the larger bony inlet to the 
pelvis. 

The powerful prepubian tendon arises from the pubic brim 
and, through the linea alba and the contributory muscles, finds 
attachment in front to the en.siform cartilage of the sternum and 
prevents the pubis and ischium from passing upwards and back- 
wards toward the sacral termination when the body weight is 
thrown upon the coxo-femoral articulation, which lies behind the 



8 Veterinary Obstetrics 

ilio-sacral joint. It plays a very important part in the large herb- 
ivora, especiail}' in the mare, where it sometimes ruptures during 
advanced pregnancy, resulting in a hernia of the gravid uterus 
and destroying the normal relation of the pelvis to the spinal 
column. (See Rupture of Prepubian Tendon, and Figs. 82, 83, 
84 and 85.) In addition to these ligaments, the great dorsal and 
psoas muscles serve an important function in maintaining the re- 
lations between the pelvis and spine. 

The pelvic cavity is somewhat conical in form in its antero- 
posterior diameter, with the base of the cone presenting forwards 
so that the pelvic inlet is somewhat larger than its outlet, a dif- 
ference which is counter-balanced fully by the fact that the inlet 
is really the only non-extensible portion of the pelvis so that, in 
practice, other things being normal, if a fetus can enter this por- 
tion it can pass through the outlet by causing its dilation. This 
distensibilit}' is dependent upon the yielding character of the 
sacro-sciatic ligament, as mentioned above. In woman, the rela- 
tions between the sacro-pubic and bisiliac diameters of the pelvis 
are inconstant, resulting in a tortuous passage, which leads to a 
rotation of the fetus on its long axis during parturition in order 
to keep the greater dimensions of the fetal body in harmony 
with those of the bony girdle through which it is passing, while, 
in our domestic animals, the cavity is rectilinear and the fetus is 
expelled in a direct, instead of a spiral line. 

In cross section, the pelvic cavity is oval in outline, departing 
but little from circular, its perpendicular usually being slightly 
greater than the transverse diameter, though these relations maj' 
be reversed. The relations between the perpendicular and 
transverse diameters do not vary materially between the inlet and 
outlet, the former being usually the greater for the entire length 
of the passage. The pelvic channel is direct and almost horizontal 
but usually directed more or less obliquely upwards and back- 
wards from the inlet to the outlet. This is especially nota- 
ble in the cow, where the pelvic floor is quite oblique and concave 
from before to behind and is further emphasized by the promi- 
nent ischial tuberosities, placed so closely together that, for prac- 
tical obstetric purposes, the summits of these may, in some cases, 
virtually mark the floor of the pelvic outlet because they are too 
close to each other to permit of the ready passage of the fetus 
between them. In the mare the pelvic floor is almost level and 



The Pelvis g 

the ischial tuberosities so small and wide apart as to be of little 
significance. 

The measurements of the pelvic cavity vary widely in different 
species, breeds and individuals so that it is virtually impossible 
to make any general statements as to the dimensions of the 
pelves of our domestic animals. The variations in size among 
domestic animals are extreme, owing to artificial selection for 
the production of giant and dwarf animals, which are widely sep- 
arated in stature. In the horse it is not rare to find animals 
weighing 250 lbs. or 2500 lbs., or a ratio of 1:10, and there is 
naturally a corresponding variation in the measurements of the 
pelvic passages. In the dog the variations are even greater in 
size, the ratio in weight being at times as great as 1:100. It is, 
therefore, quite impossible to give a reasonably approximate 
measurement of the pelves of the different species of domestic 
animals. The most important diameters of the pelvis of the 
mare to be considered by the veterinarian are the supero-inferior, 
extending from the lumbo-sacral articulation to the anterior 
point of the pubic symphj'sis ; a vertical diameter of the inlet 
from the symphj-sis pubis to the middle of the sacrum ; and a 
transverse from the most concave point of one ilium to the corre- 
sponding point on the opposite side. For the outlet, usually but 
two diameters are considered ; a vertical, from the ischio-pubic 
symphysis to the sacro-coccygeal articulation and a transverse, 
from one ischial tuberosity to the other. The measurements 
vary considerably in the experiences of different authors, the 
supero-inferior for an average horse being 9 to 10 inches accord- 
ing to Baumeister & Rueff ; 9.5 by Carsten-Harms ; 9 by Ar- 
loing and 8.75 by Saint- C3'r. The same authors make the trans- 
verse diameters II to 12.5; 9.2; 9.2 and 8.1 in. respectively. 
These authors have evidently secured their measurements from 
different classes of mares. 

In the cow, the average diameters of the pelvic inlet as given 
by various authors range between 8^'^ and 10^ inches trans- 
versel}' and 6^ to 7^ perpendicularly, with an outlet somewhat 
smaller in each of its measurements. 

The ewe and she-goat show a perpendicular diameter of the 
pelvis averaging about 4.7 in. and a transverse measurement of 
approximatelj- 3.1 in. The bitch shows a very wide variation in 
pelvic measurements, ranging from 2 to 2 1-3 in. in the sacro- 



lo Veteri7iary Obstetrics 

pubic and 1.2 to 2 in. in the transverse diameter. Similar varia- 
tions occur in the measurements taken hy the various observers 
of the other diameters of the pelvis of the mare and of other ani- 
mals, the differences being so wide as to render the measurements- 
of questionable value. Some investigators have attempted to 
establish rules for determining approximately the diameters of 
the pelves of living animals, but, thus far, have been unable to- 
turn pelvimetry to practical account in veterinary obstetrics, in 
contrast with human practice, where it acquires fundamental im- 
portance on account of the frequency of pelvic deformities, which 
often render normal parturition impossible. These deformities 
rarely occur in our domestic animals, partly because the osseous 
system is far more mature at birth than is observed in man and 
still more because a pelvis weakened by disease is subjected to- 
ne such strain in quadrupeds. The horse bears only 45 % of his 
total weight upon his posterior feet and ■ this is largely made up 
by the weight of the limbs themselves and the muscles connect- 
ing them with the trunk so that the actual weight resting upon 
the pelvis in domestic animals is inconsequential and represents 
probably less than 25 % of the total body weight, while, in man, 
it needs endure the entire body weight, except the legs themselves. 

The pelves of domesticated animals are sometimes seriously 
deformed as a result of fractures, tumors and dislocations, which 
may render parturition difficult or impossible. 

Pelvimetry in domestic animals is impracticable usually in the 
two chief groups of cases where the size of the pelvis has to do 
with dystocia. When the pelvis is deformed as a result of tu- 
mors, fractures, dislocations or rickets, the constriction is rarely 
recognized until the veterinarian is called because of dystocia, 
and he faces the question of overcoming it and must determine 
his method of procedure bj' a rough comparison of the size of the 
fetus as related to the capacity of the pelvis, as estimated by man- 
ual exploration. He is then in a position to advise the owner in 
reference to the future of the patient, whether she should be 
again used for breeding purposes, tnrned to some other available 
use, or destroyed. When dealing with such injuries in non-preg- 
nant animals, it is clearly the duty of the attending veterinarian 
to warn the owner against breeding the animal unless careful 
examination makes it clear that the patient may normally give 
birth to young. 



The Generative Orga7is i r 

In a second group of cases, excessive volume of the fetus, 
pelvimitry fails the veterinarian as he can not recognize, even if 
called to do so, this over size, until he is brought face to face 
with the consequent dystocia, and that fact alone demonstrates 
the disparity in size between the pelvic canal and the fetus, which 
is to traverse it. Nor does this occurrence, even when safely 
overcome by the obstetrist, furnish any safe criterion for future 
action except possibly suggesting a change of mating. Subse- 
quent fetuses may be of normal size. 

It has moreover been asserted that sexual differences exist in the 
pelves of domesticated animals, especially in the horse. This we 
have been wholly unable to verify. It is claimed that the pelvis 
of the mare is more ample than that of the stallion or gelding, 
that its foramen ovale is larger, that the ischiatic notch is 
broader and shallower, that the sacrum has less prominent articu- 
lar ridges ; in other words, that the pelvis of the mare is specially 
constructed as an organ of reproduction in a manner to facilitate 
the passage of the fetus at the time of parturition. We have 
critically examined a number of equine pelves and find among 
them those of stallions or geldings fulfilling the description given 
as typical of the mare in every regard and, vice versa, a mare 
pelvis fully meeting all the alleged characters of the male. So 
far as we have been able to determine, it is impossible to differen- 
tiate the sex of any species of domestic mammals by the form or 
size of the pelvis. 

B. The Generative Organs. 

The genital system of the mammalian female consists of the 
ovaries, oviducts, uterus, vagina, vulva and mammae. Writers 
variously divide them into internal and external, essential and 
subsidiary, genital or copulatory ; each, however, is influenced b}' 
the other and each is essential to normal reproduction. 

I. The Ovaries. 

In the protozoa, reproduction is effected by the division of a 
single nucleated cell into two parts, alike in form and size, the 
completion of the division establishing two individuals which 
supplant the parent. 

Reproduction in the higher forms of animal life proceeds in a 
somewhat similar manner from a single specialized cell, the ovum, 



12 Veterinary Obstetrics 

which, however, only divides after conjugation and fusion with 
the male cell, the spermatozoon, while the parental body remains 
unchanged after the separation and casting off of the male or 
female reproductive cell. 

The ova-producing bodies, the ovaries, appear early during 
embryonic life, varying in date according to species — usually at 
about one month in those of long gestation periods. The first 
traces of the ovaries are the genital ridges, which arise as longitud- 
inal eminences along the median borders of the Wolffian bodies 
and consist of a proliferation of the peritoneal epithelium at this 
point, by which several layers of cells are formed. The ridges 
appear in the human embryo at about 35 days or one-eighth 
term, in the rabbit at ] i days or a trifle after the first one-third, 
and in the sheep at 42 days or nearly one-half term. 

Connective tissue grows up into the genital ridges from the 
underl3'ing mesoblastic cells to form the skeletal frame-work and 
tubules from the Wolffian bodies grow into the ridges to consti- 
tute the tubular tissue of the ovary, but they play no known 
essential part and are said to have nothing to do with the forma- 
tion of the ova. For a time the genital ridges are alike in both 
sexes, so far as can be determined, forming the indifferent stage^ 
during which the male and female organs cannot be differentiated. 

As the genital ridges develop, the differentiation in sex becomes 
established and, in the female, the ovary soon assumes the charac- 
teristic form of the adult, varying with the species. 

While it is held that all ovarian tissues are of mesoblastic ori- 
gin, the genital epithelium, arising from the peritoneum, the 
skeletal connective tissue from the sub-peritoneal mesoblast and 
the tubular portion from the mesoblastic Wolffian bodies, we meet 
with in various animals, especially in the horse and human fam- 
ily, dermoid cysts and well defined tooth tissues in the ovaries 
and testicles. These abnormalities are variously explained b}' 
pathologists and teratolbgists. Since dermal structures and teeth 
are derived normall}' from the epiderm, it may be well to recall 
in this connection that the gubernaculum testis of the male and 
corresponding round ligament of the female extends from the ex- 
ternal skin in the scrotal region of the male and the correspond- 
ing parts in the female through the inguinal canal and ring into 
the peritoneal cavity, where it proceeds to a point contiguous to, 
if not continuous with, the testicle or ovary. Embryologists do 



The Ovaries 13. 

not make it clear whether epidermal cells may thus reach this 
region or not, nor whether the presence of this gubernaculum 
accounts for the occasional inclusion and development within the 
genital glands, of epidermal structures. 

It is also alleged by some embryologists that the Wolffian ducts 
• are of epiblastic origin and are formed from a longitudinal in- 
vagination of epiblast. 

In the outermost layer of genital epithelium, the cells are 
columnar while, deeper, they are cuboidal in form. In the deeper 
parts, the skeletal stroma divides the cuboidal or spherical cells 
into clumps or groups known as egg columns, among which are 
to be seen, usuall}' one or more in each nest, cells of large size 
with prominent nuclei, the primitive ova, which continue to 
form until near the close of intra-uterine life. Primitive ova are 
present as soon as the genital ridges are well formed and Nagel 
claims that these are not confined strictly to the genital ridges, 
but occur here and there in the region of the ducts of Mueller in 
the thickened epithelium. 

This observation of Nagel is highly suggestive in reference to 
the operation of ovariotomy in females. We frequently find 
reports of cases where females have been castrated and later have 
shown signs of estrum, and it has been held by many practitioners 
that certain of our domestic animals continue to show signs of 
estrum after they have been properly castrated. In our own 
experience, we have seen estrum recur in an aggravated form — 
nymphomania — in the case of cows, where we were sure that we 
had removed the ovaries completely. Operating a second time, 
we have found cystic Graafian follicles at the point of removal of 
the ovary. It would consequently seem that not onlj' may 
these ova exist in the tissues somewhat outside the ovary, but, 
when the gland itself has been surgically removed, they are 
capable of developing ovisacs, especially in a cystic form which 
will later produce all the symptoms of estrum, but probably 
have no living ova in them. These facts suggest to us that, in 
performing ovariotomy, the operation should not be confined to 
removing the ovary, but should include a large part, if not all, 
of the oviducts, with the contiguous tissues, .so as to be sure that 
the ova and ovisacs are all removed. 

It is contended by Nagel that there are differences in the geni- 
tal ridges of the sexes in the human embryo at as earlj- a period 



14 Veterinary Obstetrics 

as 32 or 33 days, those of the female containing primitive ova, 
while in the male there appear the tortuous cords, which are to 
become the tubuli semeniferi and, in these columns are found 
primitive sperm cells. Nagel doubts if there is any truly indif- 
ferent stage in the development of the sexual organs, but be- 
lieves that they can be distinguished at a very early date and that 
probably they are at no time exactly alike. 

The primitive ova pass inwards toward the center of the gland 
and, as they do so, undergo a progressive development, at first 
having granular nuclei of indistinct outline, which soon enlarge, 
becoming very distinct and of a regular spherical form, having a 
double-contoured wall, fluid contents and a nuclear reticulum with 
one or several nucleolar enlargements at the nodes. The whole 
egg also increases greatly in size, its protoplasm becomes granular 
and, between the ovum and the follicle or capsule, there is formed 
an elastic investing homogeneous layer known as the zona radiata. 
Having undergone this development, thej' are known as per- 
mane?it ova. 

The smaller germinal cells arrange themselves in enveloping 
layers about the permanent ova in the form of a hollow sphere, 
from the walls of which, usually near the bottom, a discoid 
eminence of small granular cells, the discus prolig-erus, appears 
and, resting in this, is the ovum, while, between the discus prolig- 
erus and the follicular wall, is the follicular liquid. Outside the 
cellular wall the follicle is furnished with a fibrous, investing tu- 
nic from the stroma of the gland and, when contiguous to the sur- 
face, has, in addition, a covering of ordinary peritoneum. To- 
gether these structures constitute Graafian follicles or ovisacs. 

Of all animal cells, the duration of life of the permane^it ova is 
best known. Unless they mature and are discharged into the 
oviducts upon the rupture of the Graafian follicles, they remain 
permanent from the date of birth, or soon thereafter, until the re- 
productive powers of the animal have ceased as a consequence of 
age. They remain in an unchanged state in the mare, for 
example, for 20 to 25 years, capable at any time during that 
period of becoming discharged into the oviducts, and, when im- 
pregnated, of developing into a fetus. In all our domestic ani- 
mals, so far as known, all permanent ova are developed at, or 
very soon after, birth and hence, whenever such of these as are 



The Ovaries 15 

•capable of impregnation have all perished through ovulation or 
other means, the fertility of the animal is at an end. 

Since the ova are formed from specialized peritoneal cells 
Tcnown as the genital epithelium, while the vessels and skeletal 
tissues are derived from the sub-peritoneal mesoblast we are pre- 
pared to anticipate the occurrence in the ovary of two somewhat 
definitely marked zones, the cortex and medulla. The peri- 
pheral cortex contains the essential ovarian cells, the ova, em- 
bedded in prolongations from the central or medullary portion, 
composed of skeletal connective tissue, vessels, nerves and pale 
muscles. The multiplication of the ova and ovisacs in the cortex 
<;auses it to outgrow the medulla and results generally in the 
formation of a well marked hilus, where the vessels and nerves 
-enter, at which point ova are usually absent. 

The skeletal tissues present an area of increased density at the 
periphery, where they constitute a firm, dense envelop, the 
tunica albuginea, over which the peritoneum extends. As the 
ovisacs develop, they tend to pa.ss centralwards toward the, me- 
dulla, and, continuing to grow as the amount of follicular liquid 
within them increases, finally occupy the entire thickness of 
the cortex and, in some species of animals, bulge out beyond the 
surface as more or less prominent, hemispherical masses or even 
protrude quite beyond the tunica albuginea as spherical out- 
jgrowths. As they mature, the external wall of the ovisac atro- 
phies and finally ruptures at the time of estrum and the ovum is 
discharged into the pavillion of the oviduct or fimbriated end of 
the Fallopian tube. (It is claimed that in rare instances in mam- 
malia the ova are accidently discharged into the peritoneal 
cavity.) Usually a Graafian follicle contains but one ovum but 
in some cases two have been recognized. The total number of 
ova in the ovaries of our domestic animals has not been deter- 
mined. In woman, the number has been estimated at about 
70,000, nearly all of which must undergo retrograde changes and 
not mature. The ova mature in cycles, varying according to 
species, climate and degree of domestication. In some well 
housed and fed domestic animals which are not pregnant, ovula- 
tion occurs every three or four weeks throughout the year. 

During oestrum the ova are discharged either singly, as in the 
mare and cow ; two or three, as is frequently observed in the 



1 6 Veterinary Obstetrics 

sheep and goat ; or in varying numbers, as in the carnivora and 
rodentia. 

It is estimated that the ovaries of a child two years of age 
are fully developed so far as the new formation of ova is con- 
cerned. Ovogenesis must cease much earlier in our domestic ani- 
mals, all of which may reach sexual maturity within one year 
from birth and are in most ways more mature when born than is 
the child when two years old. 

In old animals which have ceased to breed or to- show sexual 
desire, the ovaries are much atrophied and contain degenerate ova 
incapable of fecundation, signifying that the supply of fecunda- 
ble ova has become exhausted during the span of sexual life. 
This suggests that any estoppel of ovulation, like pregnancy, 
where the cycle is longer than that of ovulation, as in all our 
larger animals, will tend in some degree to conserve the num- 
ber of ova capable of further development. In harmony with 
this thought, we find that mares which are regularly bred tend to 
retain their reproductive powers to a later period in life than 
those which are not permitted to breed until aged, but here 
other factors, probably of greater importance, are at work. 

The rupture of the ovisac leaves a lesion which usually be- 
haves differently according to whether the discharged ovum be- 
comes impregnated and undergoes development into a fetus or, ■ 
failing of fecundation, perishes. The ruptured sac becomes filled 
with lymph, blood or other products of the disturbances of the 
tissues. Should the ovum perish, the ruptured ovisac tends to 
heal rapidly, with a faintly 3'ellowish cicatrix, which .soon disap- 
pears entirely so that no visible trace exists of the ruptured sac. 
The temporary scar is known as z. false corpus luteuni. The per- 
sistence of a corpus luteum, especially if over size, in a non- 
pregnant animal, inhibits ovulation and induces sterlitj'. ( See 
under " Sterility." " Persistent Corpus L,uteum "). 

Should the ovum become fecundated and undergo normal de- 
velopment, the scar resulting from the ruptured ovisac normallir 
attains greater dimensions, is markedly yellow in color, projects 
beyond the ovarian surface and persists nearly or up to the time 
of parturition, and is known as a true cor pics luteum. We thus 
note a bond of functional sympathy between the ovary and the 
fate of a discharged ovum, a harmony shown constantly between 
the various organs of the reproductive system. An important 



The Getierative Orgafis 17 

fact iu relation to the persistence of the true corpus luteum 
during pregnancy is a well marked tendency to abortion when 
the ovaries are removed from a pregnant female, or the corpus 
luteum is forced out of the ovary by crushing or otherwise. 

The size and form of the ovaries differ greatly according to 
species, age and individual and even the two glands in the same 
animal are not ordinarily alike and may vary greatly in size. 

The ovary of the mare is much the largest seen in the domes- 
tic animals, reniform, very dense owing to its thick tunica albu- 
ginea, with a smooth surface which is elevated here and there in 
many cases by the presence near the surface of cystic Graafian 
follicles. It attains its maximum size at the age of two or three 
years and begins to atrophy at ten to fifteen years, to finally 
become very small as age advances. The ovary of the young 
mare is usually t,]4. to 4 inches in its greatest diameter and weighs 
about 4 ounces, while, in the aged, it may shrink to 1)4 inches 
in its greatest diameter and its weight to }4 ounce. 

The ovary of the cow is much smaller, being about one inch 
in its greatest diameter, weighing but ^ to ^ ounce ; it is ob- 
long in form, more regular in outline and its tunica albuginea is 
less dense. 

The ovary of the sow is very large comparatively and the 
numerous ovisacs appear prominently on its surface to such an 
extent that the most superficial of them stand out entirely be- 
yond the general ovarian line in such a manner that they are 
attached to the body of the organ by a somewhat constricted 
neck. 

The ovary of the cat is very small, oblong, with pointed ex- 
tremities and of a bright scarlet color with the ovisacs standing 
out thickly over the surface in a way to suggest a niulberr}'. 

The ovary of the bitch is very small, dark livid in color, even 
in outline, and, unlike that of other domestic animals, is com- 
pletely enveloped in the pavillion of the oviduct, except for a 
minute oblong opening of so small size that the ovary cannot be 
exposed to plain view through it. 

Forming in the fetus, beneath and on either side of the 
notochord just posterior to the kidney, and above the perito- 
neum, the ovary descends into the peritoneal cavity, carrying 
with it the peritoneum, which thus forms a double layer behind 



1 8 Veterinary Obstetrics 

it which serves to preserve its attachment to the sub-lumbar 
region, and, between the two folds, the vessels and nerves pass to 
the gland. 

The location of the ovary in the adult varies much with 
species but, apparently, the size of the gland has little or no in- 
fluence upon its position. It rests upon the superior surface of 
the anterior border of the broad ligament, naked in most animals 
but closely invested in the bitch b}' the pavillion of the oviduct. 
The pavillion of the oviduct is attached at one point of its 
margin to the ovary near its hilus and its connection with the 
uterus is further maintained hy the utero-ovarian ligament, com- 
posed largeh^ of connective tissue and pale muscle fibers. The 
ovary is further influenced in its position bj' the round ligament, 
which is analogous to the gubernaculum testis of the male. 
Arising like the latter from the skin and dartos at the point 
where the fundus of the scrotum of the male normally appears 
in the given species, it passes up through the inguinal ring and 
above the peritoneum to became attached to the uterine cornua 
or oviduct not far from the ovary. The latter tends with these 
attachments to follow a line of descent comparable to the testicle 
but normally becomes arrested in its movement at some point 
between its place of origin and the internal inguinal ring. In 
the bitch, it remains closelj' applied to the sub-lumbar region 
immediately behind the kidne}- ; in the mare, its movement is 
arrested earh' and it remains rather firmly suspended not far be- 
hind the kidney and above the middle of the posterior part of the 
abdominal cavit)', while that of the cow lies loosely alongside the 
vagina just by the internal inguinal ring. 

In the sow, the ovarj- floats quite freel}' in the peritoneal cavity 
and at times passes out through the inguinal ring and comes to 
rest in the perineal region corresponding to the scrotum of the 
male. The same displacement is said to occur rarely in bitches 
and it is possible in any species. 

In general we might say that in the elongated uteri of multi- 
parous animals the ovaries are situated further forv^'ard than in 
the uniparous or biparous species. The location of the ovary is 
further modified bj^ the pregnant state, the gravid uterus 
■dragging it downwards and forwards in its own descent. 



The M7ielleria7i Ducts 19 

The Muellerian Ducts ; the Oviducts, Uterus and Vagina. 

I. Thk Muhij-vRkian Ducts. 

Early in embryonic life, before the genital ridges have become 
well marked, about the second month in animals with extended 
durations of pregnancy, the ducts of Mueller develop as two 
ridges beneath the peritoneum near to, but outwardly from, the 
Wolffian ducts, from which they are .said to arise as outgrowths, 
and extend forwards from near the cloaca to or beyond the 
Wolffian glands. Appearing first as solid rods, they later become 
excavated to constitute tubes, which end blindly at their posterior 
extremity for a time but later open into the cloaca or common 
vent of the digestive and urino-genital sy.stems. As soon as 
hollowed out, each vessel opens anteriorly into the peritoneal 
cavity through a large funnel-shaped mouth, the future pavillion 
of the oviduct of fimbriated end of the Fallopian tube. At this 
time there are in this region, lying parallel and near to each 
other, three separate ducts ; the ureter, the Wolffian duct to 
become the excretory duct of the male genital gland and the 
Muellerian duct to become the genital tract of the female. The 
posterior ends of the Muellerian ducts are in close contact at 
first and later, at about the time of their opening into the cloaca, 
they fuse together for a variable distance forward, their median 
walls disappearing, resulting in the formation of a .single tube as 
far as the fusion extends. 

The Muellerian ducts later become differentiated into three 
essentially separate segments through specialization of their 
development, each having its distinctive function. The anterior 
.segment constitutes the oviduct or Fallopian tube with its 
ampulla, or pavillion, which serves to receive the ovum from the 
ovary and bear it, fetilized or unfecundated, into the uterine 
cornu, or uterus ; the second or middle portion of the genital 
tube constitutes the uterine cavity, in which the fetus may find 
lodgement, attachment, nutrition and protection during its devel- 
opment ; the third or posterior .segment, the vagina, extending 
from the uterus to the vulva, serves first as an essential copula- 
tive organ and later as a passage for the fetus at the time of birth. 

The distance to which the fusion of the Muellerian duct ex- 
tends forwards and the extent of the specialization of the different 



20 Veterinary Obstetrics 

areas, modifies greatly the form and relations of the various 
segments. 

Arrests in the development of the genital tube may occur at 
any point, which may interfere more or less with its form and 
functions. The fusion in the utero-vaginial region may be partly 
or wholly arrested, resulting in a more or less completely double 
uterus or vagina or the MeuUerian ducts may fail to develop as 
such but remain as two dense solid cords, as is seen in Fig. 51 
where no uterus or vagina exists. 

A study of Fig. 51 shows that the uterine cornua and ovaries 
were apparently well developed, the cornua contained consider- 
able cavities which were distended with fluid, the ovaries showed 
Graafian follicles and a corpeus luteum. The anterior, or oviduct 
segments of the genital tubes are widely separated from each other 
and are not commonly the seat of arrest of development. 

The Muellerian ducts in the male commence to disappear at 
about the middle third of pregnancy, but small vestiges may re- 
main in the adult male as the hydatids of Morgagni, which, in some 
species of animals constitute small pedunculated bodies between 
the testis and the head of the epididymis. They are supposed to 
come from the anterior end of the ducts and are more prominent 
in man than in our domesticated animals. At the posterior end of 
these ducts, where they unite together, they are by some supposed 
to form the so-called uterus masculinus, a small sinus which ex- 
ists in the superior wall of the urethra between the seminal vesi- 
cles, at the point of emergence of the vasa deferentia. 

The entire genital tract, having a common origin, has a gen- 
eral type of construction, characterized chiefiy by each having 
three separate coats ; peritoneal, muscular and mucous. 

The peritoneal layer, which invests the genital tract almost 
completely, is derived from that of the body wall, behind which 
the ducts of Mueller originate. At the anterior extremity the 
genital tract opens, through the pavillion of the oviduct, into 
the peritoneal cavity, the continuity of the peritoneum being 
interrupted at this point to be succeeded by the mucous mem- 
brane of the oviducts. 

As the broad ligament consists of two peritoneal layers, re- 
sulting from the departure of the genital tube from its seat of 
origin behind the peritoneum, it follows that, along the line of its 
attachment to the genital tube, the investment is interrupted to 



The Broad Ligaments 21 

the extent of the area between the two folds, occupied by the 
vessels and nerves. At the posterior extremity of the genital 
tract, where it opens into the cloaca of the embryo, the peritoneal 
investment is interrupted and its place taken by the intrapelvic 
connective tissue so that, eventually, the peritoneum covers, in 
addition to the oviducts and_uterus, only the more anterior por- 
tion of the vagina ; the fusion of the two Muellerian ducts more- 
over, to form the vagina and uterus, eliminates the peritoneal 
covering on the median plane of each separate tube as far as they 
coalesce, and, following this, occurs the atrophy and disappear- 
ance of the muscular and mucous walls connecting the two, and 
the adjacent tubes become a single canal. 

The mtiscular portion is composed of transverse and longitu- 
dinal layers of pale fibers, varying greatly in the different sections 
of the tract and also according to whether the animal be pregnant 
or not. 

The mucous coat of the genital tract offers the greatest possi- 
ble variations and assumes widely differing and highly import- 
ant functions, according to the particular area occupied. 

2. The Broad I^igaments. 

. Since the Muellerian ducts have their origin outside the peri- 
toneum, it follows that in moving away from the abdominal walls 
they must carry with them their peritoneal covering. As soon 
as they drop away from their point of origin the investing folds 
of peritoneum tend to meet behind to constitute a double perito- 
neal fold, between which the vessels and nerves, along with pale 
muscle fibres pass to and from the ovaries and genital tube. 

These expanses of peritoneum, with invested vessels, nerves and 
muscles, constitute the broad ligaments of the uterus, or more cor- 
rectly speaking, of the genital canal. The ligaments act as a sus- 
pensorium for the genital tract, maintaining its connection with 
the abdominal walls and also furnishing a support for the ovaries, 
thereby fixing these organs, under certain limitations, in a defi- 
nite location. The broad ligament varies greatly in its form 
and amplitude according to species and the functional activity of 
the genital tract. In the bitch, cat and sow, in which the anterior 
extremities of the uterine cornua remain throughout the life of 
the animal, as far forward as or anterior to, the posterior border of 
the kidney, the broad ligament maintains its anterior attachment 



22 Veterinary Obstetrics 

to the abdominal wall at or near the point of origin of the ovary 
just behind the kidney ; in the cow, where the ovary and the an- 
terior end of the uterine cornua are turned backwards to the im- 
mediate vicinity of the internal inguinal ring, the attachment of 
the anterior border of the ligament likewise moves backwards for 
a considerable distance so that the middle of the recurved cornu 
tends to project anteriorly beyond the anterior margin of the 
ligamentous attachment even when non-gravid. When the 
uterus of a quadrupedal mammal becomes gravid the weight of 
the fetus drags the occupied portion downwards and forwards 
until the organ comes to rest upon the abdominal floor, in front 
of the anterior point of fixation of the ligament to the abdominal 
wall. Since the anterior attachment of the broad ligament is 
more posteriorly situated in ruminants than in other domestic 
animals, it tends to favor the revolving of the gravid uterus on its 
long axis in front of the anterior attachment. This disposition 
attains an important clinical significance in the study of uterine 
torsion (which see) in which it is observed that the tendencj' to 
torsion increases as the anterior extension of the attachments of 
the broad ligaments to the abdominal walls recedes. 

The genital tube is further maintained in its position by its at- 
tachment posteriorly to the vulva and also by the round ligament 
of the uterus, which we have alread}' described oii, page i8. 

3. The Oviducts. 

The oviducts, formed from the anterior or ovarian extremities 
of the Muellerian ducts, are two long, tortuous tubes, varying in 
length and other characters according to species. Their length 
is several times the distance from the anterior extremity of the 
uterine cornu to the ovary, thus throwing it into folds. The 
distance between the anterior extremity of the cornu and the 
ovary is fixed by the utero-ovarian ligament and not by the ovi- 
duct. In some animals the oviducts are naked and clearly visible 
while, in the bitch, they are hidden in the fat of the broad liga- 
ment and the utero-ovarian ligament is very short so that the 
anterior end of the uterine cornu is virtually in contact with 
the ovary while the oviduct, some 3 to 4 inches in length, is 
thrown into numerous folds to terminate about J4 inch from its 
uterine end, so that casual observation, without dissection, might 
lead to the assumption that the Fallopian tube was well-nigh 



The Oviducts 23 

absent in this animal, whereas it is very similar in actual length 
to that seen in other species. When divested of any concealing 
coverings of peritoneum, fat or other tissues, the oviduct appears 
as a very tortuous, iirm white cord about . i inch in diameter, of 
variable length in different species of animals. It is very firm to 
the touch and gives a sensation much like its analogue in the 
male, the vas deferens. After dissecting it out from the sur- 
rounding tissues and carefully eliminating its numerous abrupt 
curves, a very fine sound, like one of the tail hairs of a horse, ma}^ 
be inserted at one opening and passed through its entire length. 
The opening is therefore very narrow and being remarkably tor- 
tuous in its disposition it becomes difficult to pass either a solid 
object like a sound or even a liquid through it. While, techni- 
cally, the oviducts complete a communication between the peri- 
toneal cavity and the exterior, it seems virtually impassable except 
to ova and spermatozoa and does not, under usual conditions, 
permit even the forcing of liquids through them when intra- 
uterine injections are made under comparativelj' high pressure. 
Clinically, they are also well-nigh proof against the passage of 
bacteria unless we except some special organisms like those of 
gonorrhea in woman. Occasionally, however, after abortion, 
retained placenta, nodular venereal disease, etc., in cows and 
other animals, infection extends along the oviducts, causing dis- 
ease of them or, reaching the ovary, inducesabscessor other disease 
causing sterlity. 

The intimacy of contact between the peritoneum and oviduct 
varies according to .species, the investment being very close in 
ruminants and the sow so that they are readily seen without dis- 
section, while, in the mare, it is surrounded by much connective 
tissue, which serves to conceal it from view until the peritoneal 
and fibrous coverings are dissected away ; and in the bitch the 
concealment is further accentuated by large amounts of adipose 
tissue. 

The oviduct opens anteriorly through the ostium abdominale 
into the pavillion of the tube and posteriorly into the uterine 
cornu through the ostium uterinum, which usually projects 
somewhat as a small eminence into the cavity of the cornu. 

The muscular coat of the oviducts is characterized chiefly by 
its density, which gives to it an almost cartilaginous consistency, 
and its paleness, which amounts almost to translucency. 



24 Veterinary Obstetrics 

The superficial layer of the mucosa of the oviducts consists of 
ciliated columnar epithelium, with the cilia vibrating toward the 
uterus. The oviduct is the most rigid and undilatable portion of 
the genital tube and has for its office the conveyance of the ovum^ 
fecundated or otherwise, from the ovary to the uterus, in which 
function the cilia apparently play an essential part. The duct 
also provides passage for the migration of the spermatozoa of the 
male, which, advancing from the uterus toward the ovary, meet 
the ovum within this narrow passage and fecundate it. In rare 
cases the fecundated ovum lodges in this duct and undergoes par- 
tial development, to constitute tubal pregnancy (which see), but 
its undilatability serves as a rule to cause a rupture of its walls 
and leads to the escape of the fetus from the duct into the ab- 
dominal cavity to either cause sudden death of the animal from 
hemorrhage or constitute extra-uterine or abdominal pregnancy 
(which see). 

4. The Uterus. 

The uterus is a musculo-membranous sac designed for the re- 
ception, attachment, nutrition and protection of the ovum and 
finally aids in the expulsion of the fetus at the time of birth. 

Derived from the ducts of Mueller, it varies greatly in form and 
disposition, partly dependent upon the degree of fusion between 
those two structures. There are generally recognized a uterine 
body and two cornua, each having essentially like functions in 
varying degrees. 

In the rabbit, there exists no uterine body, but two distinct tub- 
ular uteri opening separately into the vagina. In the bitch, cat 
and sow the uterine body is limited in extent and physiologically 
unimportant, rarely containing even a portion of a fetus except 
in transit at the time of birth, while the two cornua are exten- 
sive and in them develop virtually all the fetuses so that, physio- 
logically, they represent the two separate uteri of the rabbit. 

In ruminants, the uterine body becomes markedly greater in 
size and assumes far higher importance physiologically, while the 
cornua remain relatively large. 

In these animals the one, two, or more fetuses habitually rest 
almost equally in the body and cornua so that they represent a 
middle point in the transition between the double uterus of the 
rabbit and the single uterus of woman, physiologically devoid of 



The Uterus 25 

cornua. In the mare the uterine body becomes relatively more 
important than in the ruminant. 

The relative importance of the cornua to the uterine body sus- 
tains a close relation to the number of young brought forth at a 
given birth. In multiparous animals, there are two uteri, as in the 
rabbit, or the two extensive cornua with functionally unimportant 
uterine body, as in the bitch, cat and sow. In ruminants, which 
are largely bi-parous, the uterine body and cornua become ap- 
proximately equal in extent and function. 

In the normally uniparous mare, the cornua are smaller than 
the body, while, in woman, the uterus is virtually without cornua 
in size or function. 

The uterus and its cornua, within the above limitations, are 
uniform in their plan of structure and function. They consist of 
three coats ; mucous, muscular and peritoneal. 

The mucous coat constitutes the essential physiologic basis of 
the organ. The mucous epithelium is very elaborate, consisting 
superficially of columnar cells, while, embedded deeply within it, 
are numerous tubular structures of a glandular character, the 
utricular glands, believed to secrete the so-called uterine milk, 
■which is presumed to play an important role in the nutrition of 
the ovum pending the formation of the embryo and the establish- 
ment of its intricate connection with the mucous membrane 
through the chorion. Yet more important, it is through a 
special elaboration of the uterine mucosa that the highly intricate 
and essential maternal placenta is formed, to constitute a phys- 
ical and physiologic bond between the mother and fetus during 
the span of pregnancy. The uterine mucosa apparently exerts a 
distinct bactericidal power and ordinarily prevents the gaining of 
■a. habitat by bacteria in the uterine cavity. 

In the non-gravid uterus, as is common with distensible hollow 
organs, the mucous membrane is thrown into numerous longi- 
tudinal folds, which permit of prompt and extensive dilation of 
the cavity without violence to this membrane. 

The muscular coat consists of two somewhat differentiable 
groups of longitudinal and circular pale muscle fibers which in- 
crease in size, number and activity during pregnancy. The 
proportion of the longitudinal to the circular fibers varies, the 
latter being much more prominent in the region of the cervix, 



26 Veterinary Obstetrics 

where they serve specially as occlusive agents to establish a sep- 
aration of the uterine from the vaginal cavity. 

The peritoneal layer of the uterus is derived from that of the 
abdominal walls and completely envelops the organ except at the 
points of continuity with the oviducts and vagina and the inter- 
stice between the two peritoneal sheets of the broad ligament at 
their points of uterine attachment. The broad ligaments have 
already been described on page 21. 

Those portions of the Muellerian ducts from which the uterus 
is later developed are formed early in embryonic life behind the 
peritoneum and later leave the abdominal walls, to float freely 
within the abdominal cavity, suspended by the broad ligaments- 
or, in the gravid state, to rest upon the abdominal floor. 

The uterus is further retained in position by its continuitj^ 
anteriorly with the oviducts and posteriorly with the vagina. 
The round ligament of the uterus, arising from the skin ordartos- 
in the region normally constituting the fundus of the scrotum in 
the male and passing up through the inguinal canal and abdom- 
inal ring and thence to the cornu or oviduct is functionally of 
little or no interest. 

The uterus of the mare, with its cornua, constitutes a some- 
what crucial-shaped organ, the horns leaving the bod}' laterally 
at right angles or somewhat recurved. It is located immediatel^- 
beneath the rectum with its two cornua passing obliquely out- 
ward and upward on either side. The uterine body is oblong, 
ilattened somewhat from above to below, varying from 5 to 8- 
inches in length and i J^ to 2^ inches wide. In the non-gravid 
organ, the mucous surfaces of its walls are normally in contact 
with each other. Posteriorly, its cavity is continuous with that 
of the vagina through the medium of the cervical canal, a con- 
stricted portion of the genital tube which serves to fix a bound- 
ary between the two cavities and to, in a measure, close the 
uterine cavity to the exterior. This canal is a somewhat 
elongated and tortuous channel, dependable for its length upon 
that of the cervix «^i?rz, which it traverses, and for its width upon 
the development and degree of contraction of the circular muscle 
fibers of the latter. 

The cervix uteri consists of a constricted area of the uterus in 
which the circular muscle fibers are comparatively much more 
numerous than in other portions of the organ. Posteriorly the 



The Uterus 



27 



cervix projects into the anterior end of the vagina for a distance 
of I to 2 inches in the form of an obtuse cone varying in its 
transverse diameter, but approximating its longitudinal dimen- 
sions. At the summit of this conical projection is the os uteri 
or OS externum, with its mucous membrane thrown into conver- 
gent longitudinal folds, suggesting the appearance of a radiating 
flower, fleur epanouie. 




-yL-O 



Fig. 2. Non-gravid Uterus of Mare viewed from above, 
WITH Right Cornh Laid Open. 

O, O, Ovaries. Ov, Oviduct. U, Uterus. UC, Uterine cornu. 
BL, Broad ligament. V, Vagina. Vu, Vulva. CI, Clitoris. 
H, Hymen. 



28 Veterinary Obstetrics 

The origin of this projection of the cervix into the vagina 
seems somewhat analogous to intestinal intussusception, a partial 
invagination of the anterior portion of the genital tube into the 
vaginal cavity. At the time of parturition this projection and 
the cervix as a whole becomes obliterated and the uterus and 
vagina temporarily indistinguishable except in the character of 
their mucosa. 

The dimensions and dilatability of the os uteri and cervical 
canal vary widely in individuals and at different times. Nor- 
mally, the mucosa of the circumference of the os uteri should be 
in contact. In the mare it should permit of the ready intro- 
duction of one or two fingers through it and along the canal of 
the cervix into the uterine cavity. 

At the time of estrum the os becomes more dilated and, fre- 
quently, readily admits three or four fingers or the entire hand. 
It is not unusual to find cases where the os uteri of the mare is 
abnormally dilated and flaccid to such a degree as to interfere 
with fecundation. More rarely in the mare the os uteri may be 
closed or the cervix very much constricted in a manner to render 
the passage of spermatozoa into the uterine body uncertain and 
thus tend to induce sterility. 

Anteriorly, the cavity of the uterine body of the mare is con- 
tinuous with that of the two cornua, without a distinct line of 
■demarcation beyond an abrupt turn at right angles or a slight 
recurvation to its long axis. This peculiar relation of the cornua 
lo the uterine body and to each other renders bi-cornual preg- 
nane}' (which see) possible in the mare (see Figs. 2, 120, 121). 
Each cornu is much like the body and the combined length of 
the two surpasses the latter in extent. They end obtusely, not 
far from the ovary, and present, on their interior, conical pro- 
jections in which there is an opening, the os uterinum, or uterine 
■orifice of the oviducts. 

In the cow, and other ruminants, the uterine body is less pro- 
nounced in size when viewed exteriorlj' and yet more so upon 
section, while the cornua are much longer, tapering and more 
ample than in the mare. The two cornua separate at a very acute 
angle and for a time extend forwards almost parallel to each 
other and then, becoming somewhat more divergent, curve down- 
wards, outwards, backwards and then upwards to end above the 



The Uterus 29 

broad ligament against the brim of the pubis and the infero- 
lateral wall of the vagina. 

The uterine body and cornua of ruminants are much more 
dense, narrower and more cylindrical than in the mare, the cer- 
vix is longer, intensely rigid, almost cartilaginous to the touch, 
while the cervical canal is longer, narrower, more tortuous and 
interrupted by transverse, as well as longitudinal rugae. It is 
very difficult and sometimes well nigh impractical to insert one 
finger through the cervical canal into the uterus. During estruni 
the OS titeri and cervical canal become more dilatable. 

The broad ligament of the uterus of the mare arises anteriorly 
from the abdominal wall in the sublumbar region not far poster- 
ior to the kidney and its parietal attachment passes from this 
point obliquely downwards, backwards and medianwards, along 
the median side of the inguinal ring and thence into the pelvic 
cavity where its two layers of peritoneum become reflected from 
the vagina upon the bladder, rectum and pelvic walls. As com- 
pared with the broad ligament of other domestic animals it is re- 
stricted in extent in the mare, especially transversely, resulting in 
a comparatively rigid fixation of the uterus and, since its anterior 
attachment is approximately in a direct line with the long axis of 
the cornua, the entire organ is held well forward in the abdo- 
minal cavity in the form of a cross, in marked contrast to the 
disposition of the organ in ruminants. 

As compared with the mare, the broad ligament of ruminants 
is much more ample transversely, while, in an antero-posterior 
direction, it is much less extensive. Its anterior point of attach- 
ment to the abdominal parieties is much farther back than in the 
mare. This variation in disposition and relations of the broad 
ligament produces two well marked clinical differences obstetric- 
ally. 

In the non-gravid uterus of the cow the anterior parietal at- 
tachment of its broad ligament is already posterior to the ante- 
rior curvature of the uterine cornua, which, in the gravid uterus, 
becomes sharply accentuated, almost the entire organ resting an- 
terior to its ligamentous attachments to the abdominal paneties. 
Thus the broad ligaments become largely powerless in prevent- 
ing the pregnant organ from revolving upon its long axis, so that 
torsion of the uterus (which see), becomes quite common in the 
cow and ewe, while in the mare, the more rigidly fixed organ, 



30 



Veterinary Obstetrics 




Fig. 3. Generative Organs of Bitch in situ. 

TT, Two posterior teats. B, Bladder. V, Vagina. U, Uterus. 
LUC, LUC, Left uterine cornu with a portion of its broad ligament, 
BL, lying across it. RUC, Right uterina cornu with its broad liga- 
ment, BL', turned outwards exposing the full length of the cornu. 
00, Ovaries. R, Rectum. K, Left kidney. AA, Dotted lines in- 
dicating level of the external ilial tuberosities: 



The Vagina 31 

with the anterior parietal attachment of the ligament much 
farther forward, renders the accident comparatively rare. 

The comparative amplitude of the ligament in the cow, with 
its most anterior point of parietal attachment but little forward 
of the pelvis, permits more readily of inversion and prolapse of 
the uterus and vagina (which see) than obtains in other animals. 

In muciparous animals the broad ligaments are necessarily 
very extensive and uniformly have their anterior point of attach- 
ment to the abdominal walls far forward in the post-renal 
region. In the bitch, the ligament at its anterior border is very 
short so that the ovary and ovarian end of the cornu is closely 
fixed in the sublumbar region just posterior to the kidney and 
tends to stretch the cornu between this anterior, sublumbar at- 
tachment and the vagina. 

The ligament being exceedingly ample except at the anterior 
border, it is much longer than the distance from its parietal 
attachments to the position of the cornu, resulting in a large 
antero-posterior fold which drops down on the median side of 
the cornu and covers it in this double fold of broad ligament. 
(Fig. 3). 

Unlike in other domesticated animals, the broad ligaments of 
the bitch are uniformly the seat of extensive deposits of fat, 
which causes them to strongly resemble the gastric omentum in 
general appearance. 

5. The Vagina. 

The vagina is a musculo-membranous canal, formed from the 
fusion of the posterior ends of Mueller's ducts and extending 
from the uterus to the vulva. L,imited anteriorly by the os uteri 
extennim, it ends posteriorly at the position of the hymen, just 
anterior to the meatus urinarius, where the vulva succeeds it. 

In the mare it is 8 to 12 inches in length and capable of lateral 
distension to the full size of the pelvic cavity. Lined with 
squamous epithelium, its mucosa is thrown into longitudinal 
folds, which, when at rest, lie in contact with each other. 

The mucous membrane of the vagina has in its deeper portions 
numerous mucous glands which serve to keep the surfaces at all 
times moist and which become especially active during sexual 
excitement and at the close of pregnancy. The muscular coat 
does not differ fundamentally in arrangement from that of the 
uterus though less in volume. 



32 Veterinary Obstetrics 

The peritoneal covering extends backwards from the anterior 
extremity three to five inches in the mare, where it becomes re- 
flected upon the rectum, bladder and pelvic walls. In the poste- 
rior portion of its course the vagina is surrounded by the loose 
pelvic connective tissue, which permits comparatively free move- 
ment. 

The function of the vagina is chiefly copulative, receiving the 
penis of the male during coition ; and during parturition it 
affords a passage for the fetus from the uterus to the vulva. 

In the mare, the organ has the power of " ballooning " or in- 
flating under sexual excitement or physical excitation. In this 
state it expands to such a degree that it fills the pelvic cavity 
completely from side to side and from floor to roof, presenting a. 
vast cavity with smooth, rigid walls, which laterally are in close 
contact with the bony or ligamentous pelvic walls, while, superi- 
orly they lie against the sacrum except in the area where the 
rectum intervenes and inferiorly with the pubis except for the 
urinar}^ bladder. 

The physiological nature of this "ballooning" has not been 
determined ; apparently it is of an erectile character. It prob- 
ably increases the safety of copulation by rendering it impossible 
for folds of the vagina to become caught by the penis and 
injured. This power of ballooning differs largely from other 
hollow organs of the body. 

The vagina of the cow has a similar ballooning power but of a 
less degree and it is possibly a general function, though less 
. marked, in the vaginse of other animals. 

The ballooning of the vagina of the mare is easily induced by 
intravagiual manipulation, by the injection into the organ of 
bland, tepid fluids or by various other means. The phenomenon 
is especially marked and easily induced by introducing the moist 
hand into the organ at the time of estrum when the inflation at 
once occurs. 

The hymen is a transverse membranous expanse stretching" 
across the genital canal marking the boundary between the 
vagina and vulva. It represents the partition between the term- 
ination of the hind gut and the proctodeum of the embryo, which 
has failed to disappear in the lower or genito-urinary division of 
the cloaca. Generally it atrophies and completely disappears in 
our domesticated animals before their birth but at times it per- 



The Vulva 



33 



sists, either as perpendicular shreds or in a broad expanse closing 
one-half or more of the genital canal. We have met an instance 
in a filly where it prevented copulation until after surgical inter- 
vention occurred, and cases are recorded of imperforate hymen 
which caused an accumulation of utero-vaginal secretions. 

6. The Vulva. 

The vulva, located immediately beneath the anus, constitutes 
the posterior termination of the genital canal and, instead of being 
derived from the mesodermic Muellerian ducts, as in case of the 
preceding organs, its epithelial covering originates from the epi- 
derm of the embryo. It opens externally by means of a verti- 
cally elongated .slit, bounded upon either side by the labise vulvse, 
which meet above and below to form the superior and inferior 
vulvar commissures. 

The vulvar labise are covered by a very fine skin, in which the 
growth of hairs ma}' be inconspicuous, as in the mare, while in 
others, like the cow, there is a prominent tuft of hairs about the 
inferior commissure. Since the parts are so scantily haired, 
their color, which, as a rule, is simpl}' that of the adjacent skin, 
becomes verj' conspicuous. In mares with white faces, eyes and 
feet, the cutaneous covering of the vulva tends also to be devoid 
of pigment. 

The prominence of the pigmentation of the skin of this part 
serves as an aid in the clinical diagnosis of the venereal diseases 
of horses (which see), in which important discolorations occur. 

The muscles of the vulva are chiefly circular and are divided 
into two groups, the posterior and anterior constrictors. The 
posterior constrictor is situated within the vulvar lips and con- 
stitutes a true sphincter, analogous to those about other body 
openings. Above, its fibers become lost in the perineum and the 
sphincter ani ; below some go to the base of the clitoris 
and some pass downwards to become lost in • the skin and 
other tissues on the inside of the thighs. The office of this 
group comprises the usual function of a .sphincter, their contrac- 
tion bringing about the closure of the vulvar opening. The an- 
terior group of muscle fibers invests the vulva in the region of 
the hymen, just anterior to the meatus urinarius, where, by their 

3 



34 Veterinary Obstetrics 

contraction, they produce a constriction on the vulvo-vaginal 
border line. 

The mucous membrane, continuous with that of the urinary 
bladder and the vagina, is covered with squamous epithelium 
and contains numerous mucous glands, which are largely dis- 
placed near the labial margins and about the clitoris hy sebace- 
ous follicles, the secretions from which are odoriferous, especially 
during estrual periods, when the odor becomes very marked in a 
manner characteristic of the species. 

Within the vulvar cavity are to be noted the meatus urinarius, 
clitoris and vaginal bulb. The meatus urinarius, or terminal 
opening of the urethra, is located along the floor of the vulva at 
a distance of three to four inches from the external opening in 
the mare. The urethral canal passes obliquely downwards and 
forwards through the vaginal floor to the urinary bladder. In 
most animals, the ineatus urinarius is comparatively small and 
inexten.sible while, in the mare, in general harmony with the 
large and freely dilatable os uteri and genital passage, it is quite 
ample. One, two or more fingers are readily passed through it 
into the bladder and it is not rare to find the opening, in heavy, 
lymphatic animals, sufficiently large to admit, without great diffi- 
culty, the entire hand. The dimensions of the meatus urinarius 
in the mare are of special significance clinically as they favor 
ever.sion and prolapse of the bladder, an accident not particularly 
rare in this animal, while extremely so in others. In the cow 
the narrow meatus urinarius is further guarded by a valvular 
membranous fold directed from the posterior border forward in a 
manner, it is claimed, to prevent the penis of the bull from acci- 
dentally entering it and wounding the bladder as a result of the 
violent copulative thrust of that animal. Nevertheless we have 
one instance recorded (see under " Accidents of Coition ") in 
which a fatal rupture of the bladder was caused in copulation. 

The clitoris is an erectile organ, analogous to the male penis 
and having in general the same tissues, form and attachments. 
It is two or three inches in length and arises, like the penis, by 
two crura from the ischial arch and passes upwards and back- 
wards to protrude from the vulvar floor just inside the inferior 
commissure and is the principal element in maintaining the form 
of this part. 



The Matnmce or Udder 35 

Its free end is lodged within a depression in the vulvar floor 
and over it extends a mucous fold, the prepuce of the clitoris. 
The clitoris and its prepuce are covered by a pigmented mucous 
membrane in which the mucous glands are displaced by sebaceous 
follicles, and the characters of the surrounding mucosa are absent. 

The clitoris is composed chiefly of erectile tissue like that of 
the corpus cavernosum of the penis. The clitoris of the bitch, 
like the penis of the dog, contains a small bone. 

The functions of the clitoris are not important, although it is 
alleged to exert an influence upon sexual excitement. In our 
observation upon a large number of sows from which the clitoris 
had been removed by an empiric, it had no influence upon oes- 
trum or fecundation and all bred normally. In the mare it is 
frequently removed for the relief of nymphomaniac vice, but 
the results are in controversy. 

7. The Mamm^ or Udder. 

The mammae are essential organs of generation ; they are nor- 
mally excited to activity only by parturition and constitute a 
necessary source of nutritive supply to the new-born animal. 
Under domestication, the activity of the milk glands has been 
highly developed in the cow and goat to provide the irnportant 
food supply to man of milk and its derivatives : cream, butter 
and cheese. 

The milk glands originate from the epiblast by an invagination 
into the subjacent parts from which is finally elaborated the es- 
sential secretory structure and the excretory apparatus. 

They are located symetrically on either side of the median line 
of the ventral surface of the body, varying in numbers approx- 
imately in accordance with the number of young usually pro- 
duced at a birth. Usually the number of mammae is in excess 
of that of the young born at one time, bufr rarely the relation- 
ship is reversed. 

Each mamma consists of a glandular parenchyma with excre- 
tory ducts traversing a conical nipple or teat, from which the 
young may obtain the secreted milk by sucking. The glands are 
covered with a very soft, almost hairless skin, containing numer- 
ous sebaceous follicles and are closely invested by a firm, fibro- 
elastic capsule derived from the abdominal tunic. 



36 



Veterinary Obstetrics 



The mammse belong to the acinous type of glands and con- 
sist fundamentally of the milk cells or acini, where the polyhe- 
dral or spherical epithelial cells form the active secretory units, 
and, from these, the milk is poured out through the small execre- 
tory ducts into more extensive canals which serve as a common 
outlet for a group of acini, constituting a lobule. 

These ducts continue to unite and form yet larger canals, which 
are few in number and, according to species, empty either into 
one, two or more milk cisterns or reservoirs in the teat, or, in 
the absence of these, traverse the length of the teat to open by 
separate orifices at the apex. Through these excretory ducts 
the milk is drawn normally by the new-born animal by sucking ; 
artificially, in dairying, it is forced out by compression with the 
hand or other means in a manner closely analogous to the suck- 
ing by the young. 



Areolar Zone ^ 



o 






Gland lar Area 




Secondary 
- Lacteal 
Bud 



Fig. 4. Section through the mammary pit of a 20 cm. long fe- 
male swine embryo after Prof ^. Magnified about 200. (Bonnet). 



The secretion of milk and its discharge from the udder bears 
some analogy to the behavior of erectile organs. It has been as- 
sumed by some that the milk is largely secreted and stored in the 
galactophorous sinuses and cisterns during the intervals between 
milking, but this is for the most part erroneous. The milk is chiefly 
stored in the epithelial cells of the milk acini until, under excita- 



The Mamma' or Udder 



37 



liou of sucking or milking, it is poured out into the milk cisterns 
and teats and thence is readil)' extracted b}^ the sucking of the 
5'oung or by the various milking processes. In some cows, mares 
.and other females the sight of their young causes an involuntary 



Teat Pit 
Glandular Area 




Glandular 
Outgrowths 



Fig. 5. A and B. Two schematic illustrations of the mammary 
jit, showing the different forms of teats. 

A, Primary teat of the cow. 

B, Secondary teat of woman. (Bonnet. ) 



38 Veterinary Obstetrics 

discharge of milk from the udder, or, when the young is sucking 
one teat, milk flows freely from the others or, even, when a milk- 
man is drawing milk from one cow, a neighboring one has an in- 
voluntary discharge of milk. 

Under the influence of anger, fear or other disturbances, the 
flow of milk, in the process of milking, abruptly ceases, the ani- 
mal " holds up" her milk and it cannot be withdrawn. 

One milker can abstract from an udder a greater amount of 
milk than another, 5ret each will withdraw with equal care all 
the milk which reaches the teat.' The flow of milk is not directly 
subject to the control of the lactating animal, but involuntary on 
her part, subject to external influences over which she exerts 
but very imperfect power. 

In the mare, there are two hemispherical mammse, flattened 
from side to side, situated in the inguinal region and each closely 
attached in the region of the external abdominal ring, through 
which their chief vessels and nerves pass. 

There are two or more milk cisterns in each gland, from which 
corresponding excretory ducts pass to the apex of the teats to 
escape by separate orifices ranged one behind the other in the 
broad, antero-posteriorly flattened nipple. 

In ruminants, the mammse are also inguinal. In the cow, the 
right and left halves of the udder are quite distinct from each 
other although lying in contact, their fibro-elastic envelopes being 
completely separated by areolar tissue. Each lateral half is 
divided into two intimately connected "quarters," an anterior 
and posterior, with separate excretory ducts and teats. 

Each quarter has but one milk cistern, and this is of great size, 
into which all lacteal sinuses lead and from which a single excre- 
tory duct opens through the apex of the teat to the exterior. 

There are generally one or two rudimentary glands with teats 
behind the posterior quarter, which frequently function very 
slightly immediately after calving, while, in some cases, thev 
secrete a noticeable amount of milk. In one cow observed by the 
author each lateral half of the udder consisted of a single gland 
or " quarter " with but one teat like that of the ewe or goat. 

In the bitch and cat there are eight to ten mammae and, in the 
sow, ten to twelve. In the mammse of the .sow there are two or 
more small milk cisterns to each gland, each of which opens at 
the apex of the teat by a separate orifice. The mammae of car- 



The Mammae or Udder 39 

nivora possess no milk cisterns, each of several large milk canals 
opening separately at the apex of the teat. 

Rudimentary mammary glands occur in male animals in har- 
mony with the general rule that the sexual organs of each sex 
tend to be repeated or to possess an analogy in the other. lu 
rare cases, the mammae of males become functional and he-goats 
and bulls have been known to yield milk. 

In the female the secretion of milk normally becomes estab- 
lished only as a result of pregnancy and the milk appears ordi- 
narily onlj' near its termination, within a few days of the birth 
of the young, and reaches its greatest activity generallj' shortly- 
after giving birth. This is not constant. If abortion is threat- 
ened in a pregnant animal, especially a mare, when the normal! 
period of pregnancy is not nearing its close, the secretion of milk 
is liable to become suddenlj' established. In some animals the 
mammas becomfe excited, swollen and even function during 
estrum. Such was the case with a mule observed by the author, 
from which there was a very profuse and annoying flow of milk,. 
keeping the legs constantly wet during the spring of the year,. 
when she was in estrum much of the time. 

If a fetus perishes within the uterus of a uniparous animal 
without decomposition, its continued presence in the uterus fails 
to excite lactation and tends to prevent bj' its presence the occur- 
rence of estrum. 



OBSTETRICAL PHYSIOLOGY 
Reproduction. 

The specific function of the generative organs is the pro- 
creation of the species, including conception, the intra-uterine 
nutrition and development of the fetus, its expulsion after a cer- 
tain degree of development and its further nutrition for a time 
after birth by milk from the mammas, until the young has ac- 
quired sufficient development to enable it to lead a wholly inde- 
pendent existence. The two sexes in mammalia are normally 
wholljr distinct so that, before conception can take place, a con- 
jugation of the male and female, coition or copulation, must oc- 
cur. In all mammalia there are more or less apparent vestiges 
of each part of the genital apparatus of the opposite sex in each 
individual, but they naturally become arrested in their develop- 
ment in the embryonic stage and remain wholly functionless ; 
rarely do we meet with anomalies (hermaphrodites) in which the 
analogous organs of both sexes develop more or less completely ; 
less rarely we observe the development of some of the male or- 
gans (testes) and others of the female (uterus and vagina) in one 
individual. These animals partaking of a bisexual nature are, so 
far as we have observed, uniformly sterile. In other instances 
(freemartins), all genital organs may be arrested in the embry- 
onic stage and the animal remain virtuallj' asexual. 

Before reproduction becomes possible the breeding animal must 
have reached the period of pubertj' or sexual maturity, the period 
when ova and spermatozoa mature and are discharged and sexual 
desire is established, up to which time the reproductive organs 
are dormant in so far as their specific functions are concerned. 
Puberty or sexual maturity occurs at varying ages in different 
species, breeds and individuals. Much depends upon the food 
supply and rapidity of growth. It quite uniformly occurs in both 
sexes prior to the completion of growth. There seems to be a 
tendency towards earlj' puberty in short lived species and late in 
those which normall}' have a long span of life, but the rule is in- 
constant. The normal duration of life in the cow is approxi- 
mately twice that of the bitch, but the former tends to become 
sexually mature at an earlier age than the latter. 
40 



Reproduction 41 

The rate of reproduction varies greatly in different species and 
is dependent chiefly upon three factors ; the age of puberty and 
duration of sexual competency, the number of young brought 
forth at a given birth and the frequency of parturition. Uni- 
parity, or single births, is the rule in the larger animals ; the 
smaller ruminants are to a great extent bi-parons, while the 
smaller classes of animals are quite uniformly multiparous and 
bring forth from three or four to twelve or more 3'oung at a given 
time. 

The frequenc}' of parturition varies greatly and the minimum 
between two births is fixed b}^ the duration of pregnancy, which, 
among our domestic animals, finds its extremes between the four 
weeks of the rabbit and the 21 months of the elephant. The fre- 
quency of partuition is further influenced by a dormant period 
in reproductive activity between the giving of birth to young and 
readiness to again conceive. In some species the nursing of 
young tends to inhibit the power of breeding, as is sometimes 
seen in the mare and is said to be yet more marked in the ele- 
phant. In all our larger animals there is usually an interval be- 
tween the birth of a fetus and the power to conceive, pending 
the recurrence of estrum and ovulation. In the mare this inter- 
val is very brief, frequently but eight or nine days, while in the 
cow it is longer. In these larger animals there is a tendency 
toward one parturition each year and in the mare the resumption 
of the power of conception after foaling needs be very prompt or 
annual breeding becomes impossible, since the duration of preg- 
nancy is about eleven and one-third months, exceeding 12 months 
in some ca.ses, leaving an average of but about three weeks, in 
which pregnancy may recur, and a second foal be born within a 
year. Under such conditions it is natural that the mare does not 
usually produce a foal each year over an extended period. On 
the other hand, in the rabbit, conception normallj' recurs within a 
few hours after giving birth to a litter of young, so that she may 
breed each month. In nature, and still more in the domesticated 
state, conceptions fall far short of the maximum possibilities and 
the births are relatively much below the assumed number. Mares 
used especially for breeding purposes produce ordinarily but two 
foals in three years or even less, and elephants are said to pro- 
duce young but once in three to four years. Exceptionally, we 



42 Veterinary Obstetrics 

meet with mares breeding anuually for ten, twelve or more con- 
secutive years. 

Neither do all animals born reach maturity. Their growth 
and development afterbirth is predicated upon the available food 
supply and their immunitj' from predatory animals and from 
diseases and accidents. Speaking generally we might safely sa3^ 
that in the wild state the probabilities of maturity are in inverse 
ratio to the rapidity of reproduction. In those which reproduce 
slowly, like the mare, with less than one young per annum, which, 
in turn, needs live about three 5'ears before giving birth to young, 
the new-born animal is born in a well matured state and is 
quickly able to travel long distances for food or water and to 
flee rapidh' from pursuing predatory animals and enjoys, in addi- 
tion, highly efficient maternal protection. On the other hand, 
the young of the rabbit are born in a state of utter helplessness 
against enemies or of procuring food independently, while the 
mother is not competent to afford effective protection against 
foes. Thus, in a state of nature, where there is neither room nor, 
food for all the young which might be born, agencies which 
modify the birth rate and the percentage of young which shall 
successfully mature serve to maintain a balance in animal life. 

The rapidit)^ of the increase of a species is also modified by the 
available nutritive surplus of the mother. Generally speaking 
the larger the animal the lower the nutritive reserve. The 
greatest drain upon the nutritive supply is that upon the muscles 
for locomotion. Large animals need move over a more extensive 
area in order to obtain sufficient food and, the greater the bodj', 
weight, and, especially, the greater the height, the greater the 
drain upon the nutritive supply within the body. 

Among domesticated animals, where food and protection are 
provided by man, the control of the numbers of animals is brought 
about through such agencies as slaughtering the immature ani- 
mals for human food (ruminants and swine), the direct control 
of numbers by killing the surplus new-born (carnivora), castra- 
tion and the prohibition of breeding by sexual segregation. 

The maintenance of nutrition of the body of the parent must 
necessarily take precedence over the reproduction of young, and 
the latter be limited constantly by the nutritive reserve within 
the parent after the necessities for her own existence have been 
supplied. The drain upon the maternal system in the reproduc- 



Reproductio7i ■ 43 

tion of young is very great in all mammalian animals but differs 
widely according to species. In a mare weighing 1,500 pounds, 
the new-born foal may weigh about 125 pounds, or 8 % of her 
body weight, to which must be added an additional demand of 
the young, in the form of milk as food, covering a period of five, 
six or even more months after birth. 

The nutritive demands of the fetus of the mare extend over a 
long period, comprised of eleven and one-third months of preg- 
nancy and five, six or more months of nursing, or a total period of 
about one and one-half years. And her average rate of producing 
young is reduced to approximately one in two, or two in three 
years. In the cow there is a greater nutritive excess or reserve and, 
while the young is .somewhat larger as related to the size of the 
mother than obtains in the case of the mare, or about 10 %; the 
intra-uterine term of existence is shortened from about eleven and 
one-third to nine and one-third months; and the period of sucking 
is also reduced somewhat, thus materially decreasing the demands 
upon the maternal system, with a corresponding increase in repro- 
ductive power and the rate of increase of the species. In the 
natural state, fewer of the young reach maturity. In multipara 
the young are relatively smaller, but parturition occurs more 
frequently. In the sow, parturition occurs about twice annually 
and the number of young may reach ten or more at each birth. 
A sow weighing 300 pounds may thus give birth to twenty pigs 
in a year, each of which maj^ weigh two, or a total of forty 
pounds, equal to 13 % of the maternal body weight. 

The character and abundance of food exerts a well defined 
influence upon the number of young produced, a highly nutri- 
tive and well balanced ration with other favorable environment 
tending to greatly increase fecundity. 

The completeness of development of the fetus at birth varies 
widel}' and the demands upon the nutritive reserve of the 
mother correspond to the degree of embryonic evolution at- 
tained by the young prior to. birth. The iiew-born rabbit, after 
four weeks of intra-uterine life, is a very immature animal, inca- 
pable of locomotion, its eyes not open and its body almost naked 
of hair ; the young Guinea pig, after the same duration of 
intra-uterine existence, is born with a dense coat of hair, with 
eyes open and its locomotory apparatus so completely developed 
that it can move about with almost the same celeritj' as its dam. 



44 * f 'eterinary Obstetrics 

The young of carnivora are born in a very immature state, while 
those of ruminants and solipeds are well developed and early 
ready to follow their dams at will. 

In each case, there are probably advantages to the mother and 
offspring. The rabbit must depend wholly upon flight for pro- 
tection against foes and would evidently suffer a serious disad- 
vantage from a greatly increased body weight due to the presence 
in the uterus of a number of very large fetuses ; the bitch, in 
the natural state, must depend upon the chase for her food, and 
she too would be hampered by a great weight due to well devel- 
oped fetuses. 

Reproduction is a complex physiologic process, accompanied bj' 
or associated with phenomena which bear an important relation 
to each other. In approximately the following order, we observe 
the maturation of the ovisacs or Graafian follicles: estrum, copula- 
tion, rupture of the Graafian follicles, fecundation and possibly 
menstruation. The chain of phenomena is finally completed by 
pregnancy, parturition and the niitrition of the new-born. 

Maturation of the Graafian Follicle. — Ovulation. 

Recounting briefly our previous allusion on page 1 1 to the forma- 
tion of the ovaries and their specific function, the formation of ova, 
there is observed very early in embryonic life the two genital 
ridges forming along the median .side of the Wolffian bodies. Con- 
sisting at first of a mere thickening of the peritoneum, chiefly due 
to an elaboration of its epithelium, the external cell layer be- 
comes columnar in contrast to the surrounding squamous cells, 
while the deeper strata assume a more or less cuboidal form, to- 
gether constituting the germinal epithelium. This continues to 
thicken and certain of the cells become distinctly larger than 
the others, to constitute the primitive ova, while the deeper epi- 
thelial layers are being broken into irregular columnar masses, 
or egg columns, through the growth among them from below of 
blood vessels and connective tissue. Prior to birth in those 
young which are born in a well developed state, shortly after 
birth in the immature young like that of the rabbit, some of the 
primitive ova become materially changed, to CQiws\\\.\i.\.% permanent 
ova. 

In the process of development the connective tissue stroma 
throws out a thin layer, the tunica albuginea, parallel to the sur- 



Maturation of the Graafian Follicle 



45 



face of the ovary and serving to divide the germinal epithehum 
into a superficial, columnar la3'er and a deeper one broken up 
into irregular columns or clumps of spherical or polygonal cells. 
In these cell masses t\\& permatietit ova, developed from the prim- 
itive ova, become much larger, while the nucleus or germinal 
vesicle enlarges and its enveloping membrane becomes distinct. 
The contents of the nucleus become massed at one point and 
form a distinct reticulum, in which one or more nodal points en- 
large to constitute the nucleoli or germinal spots. The neighbor- 
ing germinal cells become arranged about the ovum in a manner 
to completely enclose it in a follicle, which has at first a single 
layer of cells. Later a .second layer of cells forms about the ovum 
within the first. 




Fig. 6. Section through part of the ovary of an adult rabbit. 
The section is taken vertical to the surface of the ovary, and shows 
one fully formed Graafian follicle, and others in various stages of 
development. X 50. 

GA, Follicle cells surrounding an ovum. 

GB, outer layer of Graafian follicle, or " tunica granulosa." 

GC, inner layer of Graafian follicle or " discus proligerus." 
GK, Cavity of Graafian follicle. 

OE, Outer layer of columnar epithelial cells, investing the ovary. 
OW, Ovum. OY, Primitive Ovum. 

OZ, Nests of Epithelial cells derived from the deeper layers of 
the genital epithelium. ( Marshall. ) 



46 Veterinary Obstetrics 

The cells of the follicle multiplj' rapidly and, the growth of the 
external layer being more rapid than the inner, there results a 
separation between the two, except at the point of attachment of 
the ovum, revealing upon section, a cresent-shaped cavity which is 
filled with fluid. 

Fully developed, this constitutes the Graafian follicle, which 
consists of the outer layer of follicular cells or tunica granulosa, 
the inner mass of granular cells or discus proligerus and the ovum, 
attached within or upon the inner cell mass. The cavity of the 
follicle is occupied by the follicular fluid. The ripening egg sacs 
lie at first deeply in the ovary ; as the size of the follicle increases 
they approach more and more nearly to the surface and even pro- 
ject beyond in varying degrees dependent somewhat upon species. 
They vary greatly in size. In the mare they are not readily 
observed upon the outer surface owing to the dense, heavy tunica 
albuginea and to the fact that they ripen and rupture in the con- 
cealed hilus instead of upon the free surface as in most other 
species. The exposed surface of the ovary is frequently occupied 
by massive cysts, or over-di.stended follicles. 

In the cow, the ripe follicles are prominent upon the ovarian 
surface while, in the sow, they project entirely beyond and main- 
tain their connection by a constricted neck. As the follicle be- 
comes more and more distended it ruptures at the weakest part 
of its wall and discharges its ovum or ova, with the follicular 
fluid and portions of its inner cellular layer, upon the surface of 
the ovary, where the ovum is normally taken up at once by the 
pavillion of the oviduct and conveyed toward the uterus. In 
some cases, the ovum is not discharged promptly or even at all 
from its follicle, but may become fecundated and developed there, 
constituting ovarian pregnancy (which see), while in other in- 
stances it possibly escapes free within the peritoneal cavity. 

During this period of maturation and rupture of the ovisac, the 
ovum itself undergoes important changes and, prior to its dis- 
charge from the follicle, its nucleus leaves its center and passes 
toward the periphery ; a definite vitelline membrane is formed 
within the zona radiata immediately about the egg : the nucleus 
becomes indistinct and, while the yolk or vitellusSretracts slightly 
from the vitelline membrane at one point, the first polar body, a 
small mass apparently derived from an unequal division of the 
nucleus, is assumed to be extruded, soon after which the 



Ovulation 47 

rupture of the ovisac occurs with the escape of the ovum into 
the pavilHon of the tube and, following this, while the egg is 
moving along the oviduct, before impregnation has taken place, 
the second polar body is supposed to be cast off. 

The exact relation of ovulation to estrum and menstruation 
has not been determined with complete satisfaction, and conflic- 
ting views are held. In my personal experience in spaying 
cows, it has been constantly found that one in estrum has, in one 
ovary, a ripe Graafian follicle which is ready to rupture and usu- 
ally does so on being removed, while, if estrum has occurred on the 
previous day, a fresh corpus luteum is present. This indicates 
that, for the cow, estrum normally signifies the presence in the 
ovary of a mature Graafian follicle, about to rupture, and that 
copulation with the male usually takes place prior to the dis- 
charge of the ovum from its ovisac. Later, menstruation may 
occur if impregnation has not taken place. 

Observations on rabbits are similar. When young are born, 
there already exists, in the ovaries of the doe, a crop of ovisacs, 
fully matured and readj' to rupture. Estrum follows at once 
upon the birth, copulation occurs, and it is not until after eight 
to twelve hours have elapsed that the ovisacs rupture and dis- 
charge their contents into the pavillion of the oviduct, there to 
become fertilized by the male cells already present. Such is 
probably in a large measure the rule with other animals. There 
are reasons for believing that ovulation is favored and at times 
possibly hastened by coition, but there is no definite relation and 
the ovulation regularly occurs in the absence of sexual contact. 

Ovulation occurs in more or less fixed cycles and is modified 
somewhat by climate, season, food and housing. In the mare it 
usually takes place at intervals of about four weeks during spring 
and early summer, is less frequent and more irregular during 
autumn and may be quite absent during winter, except she be 
well fed and housed. The cow ovulates with considerable regu- 
larity about every three weeks and, if well housed, the cycle is 
not liable to interruption during the winter months. 

In the ewe, ovulation apparently occurs every two or three 
weeks, but its existence is not very evident, except in the pres- 
ence of the male. In carnivora ovulation ordinarily occurs semi- 
annually in late winter and early autumn. 



48 Veterinary Obstetrics 

In all animals ovulation is normally suspended during preg- 
nancy, but exceptions to this rule occur. 

In some cases the Graafian follicles become over-distended with 
follicular fluid, their walls are abnormall}^ resistant, the ova tend 
to perish, while the enlarged ovisacs persist and grow, and ovu- 
lation does not occur. The presence of such ovarian cysts gen- 
erally inhibits the ripening and rupture of other follicles and, 
thus, not only causes sterility (which see) but exerts a profound 
influence upon the behavior of the animal, tending to cause nym- 
phomania, or sexual insanity. 

2. ESTRUM. 

Reproduction among higher animals is fundamentallj' the re- 
sult of an irresistible sexual desire occurring simultaneousl}' in 
the male and female and leading to coition. 

The condition is known as estrum in the female and, as related 
in the preceding section, occurs immediately prior to or concur- 
rentl}' with ovulation. It finds expression in various ways with 
different species of animals. In general there is a nervous excit- 
ability, the external genitals are swollen and vascular, there is 
an increased secretion of mucus from the vulva and vagina. In 
the mare there are frequent emissions of urine in small quanti- 
ties, especially in the presence of other horses, most of all of a 
stallion, the vulvar lips are frequently opened and the erected 
clitoris protruded. In ruminants and the sow the female imitates 
the copulatory act of the male by mounting other animals of its 
species. In certain pathologic cases, the cow, especially, does 
not confine her expressions of sexual desire to her own species, 
but when affected with nymphomania may attempt to mount 
other species of animals and we have known instances where 
they have even attempted to mount man and subjected him to 
very serious danger. 

In all animals there is a tendency for the female to wander 
from home during estrum. This is most noticeable in carnivora, 
which, if not securely confined, regularly disappear and tend to 
wander long distances and remain awa)' during a large part or 
all of the estrual period. In all animals there is a more or less 
apparent odor characteristic of estrum and peculiar to the species. 



Copulation. Coition 49 

3. Copulation. Coition. 

Natural reproduction in higher animals can only occur as a 
result of copulation, which, in its turn, is brought about by the 
irresistible desire of the female, which we term estrum, and the 
corresponding sexual excitement of the male. Artificially im- 
pregnation is possible and has been practiced to some extent by 
breeders, b}' injecting the seminal fluid of the male into the 
uterus of the female. 

During the act of copulation the semen from the male is in- 
jected into the vagina of the female, possibly in part into the 
uterus. We have no definite data as to where the semen is 
deposited during copulation. It is thought by many that most 
or all of it is ejaculated directly through the cervical canal 
into the body of the uterus, the urethral opening of the male 
coming in direct contact with, or entering, the os uteri. Harms, 
quoting Duranton (Journal de Lyon, 1888) cites a case of rupture 
of one of the cornu of the uterus of a cow during copulation, 
owing to the entrance of the penis through the cervix. On the 
other hand, as related below, in case of the mare, with a far more 
dilatable cervical canal, injuries from too long a penis occur in 
the vagina and not in the uterus. We have also known of a 
stallion with a considerable portion of the penis amputated which 
was quite as fertile after as before the operation, although it 
would seem that the stump of the organ could not well reach the 
OS uteri. The essential condition to fecundation, so far as the 
male is concerned, is that physiologically perfect spermatozoa 
shall gain the cervical canal, traverse the uterus and oviducts 
and meet the ovum. From among the countless myriads of these 
sperm cells in onedischarge of semen, but one of them is essential 
for the fertilization of an ovum. 



THE DANGERS AND INFECTIONS OF COITION. 

Injuries and dangers to animals during copulation or prepara- 
tory thereto, involving both sexes, are not uncommon and are fre- 
quently of a serious character. They include physical injuries 
to both male and female, the transmission of infectious diseases 
of a general character and that of specific venereal disorders. 

I. Physical Injuries. 

In the wild state, severe and fatal battles between rival males 
are not infrequent and the same prevails to some degree among 
domesticated animals, although, as a general rule, if several males 
are kept together with a number of females they lose much of 
their combativeness without, however, completelj' eradicating it. 
The author has seen an instance of a fatal fray between two 
rams which had been regularly kept together. 

When a strange male wanders into a herd or group of females 
with which a male is regularly consorting thei"e is at once a de- 
termined fight between the two, which ends only with one or the 
other becoming vanquished. In these battles, injuries of the 
most diverse character occur, according to species and chance. 
Their only prevention depends upon the proper confinement of 
male animals. 

In most countries there are laws against the running at large 
of male animals but, by custom, these are not enforced against 
carnivora, an exception which should be overcome by the con- 
finement of all females. 

There are further dangers, chiefly to the male, of injuries in 
attempting to escape from or break into enclosures in order to 
reach females, especially with horses and cattle. The appear- 
ance of a female in estrum near by the enclosure of a male is a 
signal for him to make violent attempts to escape from his con- 
finement and reach the female. It is consequently of importance 
that enclosures intended for the confinement of male breeding 
animals should be especially secure and, as far as possible, all 
elements avoided in their construction which would endanger 
the animal in an effort to escape. 
50 



Physical Injuries 51 

In the preparations for copulation there is little danger except 
in case of horses. Breeding customs and conveniences bring 
into the procedure a period of "trying" or "teasing" of the 
mare by the stallion, both for the purpose of determining the 
existence of estrum and bringing about the desired degree of 
sexual excitement before permitting an attempt at copulation. 
In this act there are numerous dangers, especially to the stallion. 

It is desirable, if not frequently essential to safety, that special 
conveniences for restraint be provided for this purpose. They 
should consist ordinarily of a strong, solid wall about three feet 
high and ten to twelve feet in length with a rather broad and 
roimded top. The chief object of the structure is the avoidance of 
kick wounds which may be inflicted upon the stallion by the mare. 
To this end it should be merely of sufficient height to guard 
against such an accident and sufficiently resistant that the mare 
cannot kick through it. The use of a single pole to separate 
the stallion and the mare is insecure and hazardous as either 
may kick through beneath it and injure the other. 

It is also highly essential that the top of the structure be 
rounded, smooth and free from projections. Either the mare or 
stallion may get bej'ond the control of the groom and kick or 
leap upon the structure and, unless properly built, serious injury 
is liable to occur. To this end the wall should be low enough 
that, either animal, getting upon it by rearing or kicking, may 
readily free, itself without injury. 

In one instance the author attended a stallion, which, becom- 
ing impatient, had passed beyond the control of the groom, 
reared to mount the mare and became impaled upon a projecting 
post at one end of the structure, causing a serious hernia and 
almost eventration. Posts should not extend above the top of 
the structure or, doing so, should continue so high as to make 
injury in this manner impossible. 

When this preparatory period has been passed and copulation 
has been decided upon, there arise fresh dangers to the stallion 
from kicks by the mare while approaching her or in the act of 
mounting. Two methods of avoiding accidents at this point are 
used ; without and with hobbles. In the first method, when both 
stallion and mare are well broken and controllable and competent 
grooms have each well in hand, the stallion should be caused to 
approach the mare's head and then allowed to mount from the 



52 ' Veterinary Obstetrics 

side instead of from the rear. If both are kept well in hand, any 
attempt to kick on the part of the mare should be at once coun- 
teracted by vigorously drawing her head toward the stallion, thus 
turning her heels from him. After coition has been completed 
and the stallion is dismounting the same rule should constantly 
be applied and the mare brought at once to face the stallion in 
order to avoid kicks. 

Owners of valuable stallions generally prefer to obtain yet 
greater security b}' the application of hobbles. Two forms are 
used, of which there are numerous varieties. By one plan, a 
hobble is buckled about each hind pastern, a rope of sufficient 
length attached to each, and the two free ends are carried forward 
between the forelegs and securely tied to a strong collar or the 
ends may be carried upwards on either side of the neck and tied 
on the top sufficiently tight to prevent the mare from kicking 
backward for any important distance. By the second plan, the 
hobbles are attached to the hocks instead of the pasterns. In 
this case, each hobble is double and one portion of each is attached 
above, the other below the hock of each hind leg and by ropes or 
straps are fixed forward the same as in the preceding. The latter 
possesses some points of superiority. The mare is not so liable 
to become entangled in the ropes and injure herself and the stal- 
lion is probably also exposed to less danger of getting his foot 
caught in the securing apparatus. Whatever the form of breed- 
ing hobbles or other confining apparatus, they need be secure and 
strong. Nothing can well be more dangerous for the breeding 
stallion than insecure hobbles which lead to a false feeling of 
security and throw the otherwise careful stallion groom off his 
guard. In a recent instance the author was called to attend a 
valuable stallion suffering from a compound tibial fracture, the 
result of a kick during attempted copulation. Because the mare 
was not properly in estrum or for other reason she was unex- 
pectedly cross and at a critical moment when the stallion was 
attempting to mount she commenced to kick and the old hobbles, 
in which the owner of the stallion had trusted, gave way, and 
the fatal accident at once followed. The breeder should never 
trust partly to hobbles and partly to the gentleness of the mare 
or good luck. If hobbles are to be trusted at all, the breeder 
should know that they are so strong that no mare can break 
them and always allow a safe margin of strength beyond that 



Physical Injuries 53 

considered essential and the fastenings should be secure in 
ever}' detail and beyond the possibility of slipping or accidental 
detachment. 

If accidents are to be avoided, it is also highl}' important that 
the mare is properly in estrum and that she is not frightened or 
angered. Gentleness and patience in the handling of both stal- 
lion and mare and postponing copulation until the proper moment 
are always es.sential elements of safety in breeding. Some 
breeders place a twitch upon the mare's nose until the stalliou 
has safely mounted her. 

In breeding mares to jacks, it is customary to place the mare 
in a pit where she is closely confined and rests upon a plane a foot 
or more lower than that upon which the jack stands. This not 
only gives an advantage to the comparatively small male bj' 
affording him an elevation, but also secures him against kicks 
from the mare, a highly essential precaution because the mare 
ordinarily resents copulation with the ass, so that the act is 
largely in the nature of rape. 

False copulation, or entrance of the penis into the anus in- 
stead of the vulva, is possible in almost any of our domestic ani- 
mals and Harms records it as occurring in the mare, cow and 
sow. The author has observed it onljf in the mare and, in all, 
four times, though he has known of numerous other instances. 
It is by no means rare and is highly dangerous. Its causes are 
various but it is probably largely due to some resistance on the 
part of the mare as a result of not being properlj' in estrum or 
otherwise becoming excited and attempting to kick or move 
about. 

Coition is safe only when estrum is present in the proper de- 
gree. The mare has ample power to close the vulva against the 
ready entrance of the penis and thus cause it to glide upward 
and forwards against and into the anus, which opening may be 
more readily forced. 

The accident is also invited in aged cows or mares with pendu- 
lous abdomen in which the anus is retracted and, drawing the supe- 
rior commissure of the vulva with it, causes the vulvar opening to 
approach the horizontal instead of the perpendicular and the penis 
to glide forward and slightly upward over the oblique vulvar 
opening to strike against the inferior surface of the tail and be 
•deflected into the anus. It may be purely accidental. Harms 



54 Veterinary Obstetrics 

thinks it may result from smallness of the female. All cases we 
have observed have been in mares of medium or large size, whether 
viewed actually or comparatively as related to the size of the 
stallion. 

The extent of the injury varies. Apparently, the accident may 
cause little or no injury in some cases, though, in those which are 
brought to the attention of the veterinarian, a large proportion 
are fatal. The extent of the lesions will vary according to 
the size and form of the penis, the violence of the copulator}' act 
and the quantity and character of the feces in the posterior por- 
tion of the rectum. Should the rectum be quite empty or filled 
only with pultaceous feces, as in a cow, or in the mare on green 
food, the penis may force its way along in the bowel unless it is 
caught in the folds. If the rectum is impacted with dry feces, as 
is usually the case in the mare, the penis is deflected and tends 
to pa.ss through the rectal walls. The rupture may occur either 
into the peritoneal cavity or into the periproctal connective tis- 
sue. In the former case in the mare, the opening is so great 
that feces at once drop into the peritoneal cavity and cause pro- 
found irritation. No sooner has the stallion dismounted than 
the mare trembles, looks anxiously at her sides, may pass some 
feces and blood, moves uneasily and may lie down but does not 
roll violently. The pulse is rapid and weak, the breathing is 
shallow and quickened, the abdomen is held rigid and the patient 
looks as if tympanitic. 

The symtoms resemble in manj' particulars those of rupture of 
the stomach. The diagnosis is readily made by manual explor- 
ation per rectum, the hand easily passing out through the rup- 
ture into the peritoneal cavitj'. In one of our cases of rupture 
into the peritoneal cavity, the mare lived some eight hours ; in 
another, less than four hours. 

Not all cases lead to rupture into the peritoneal cavity. In 
one instance under our observation, in an old brood mare, no his- 
tory of injury was obtainable and apparentlj^ it had not occurred 
during the several years of ownership by her last proprietor. 
She died under symtoms of colic and an autopsy revealed a large 
intra-pelvic sac, opening into the rectum, which had been habit- 
ually filled with feces but, becoming over distended, had obstructed 
the bowel and caused a rupture of the sac into the peritoneal cav- 



Physical Injuries 55 

ity. It was almost certainly the result of a long-standing penial 
wound. 

In another case to which the author was called the accident 
was recognized at the time of its occurrence, blood and feces 
were voided, the perineal region was swollen. Manual explora- 
tion revealed a large rent through the rectal walls into the peri- 
proctal connective tissue six to eight inches from the anus, con- 
taining a mass of feces equal to about two liters impacted into 
the readily distensible wound. The feces occupj'ing the sac and 
those from the rectum immediately anterior to the rupture were 
carefuU}' removed by the hand and the sac was cautiously flushed 
out with an antiseptic solution. This method of handling, re- 
peated twice daily, along with restricted, laxative diet and com- 
plete rest, brought about a prompt recovery with little sacculation. 

According to Harms, false copulation in the sow is usually fol- 
lowed by no more serious consequences than a swollen anus, 
accompanied by a bloody discharge. 

In the mare the accident is preventable by ordinary precautions 
on the part of the stallion groom,, whose duty it is to see that the 
penis is guided into the vulva or, at least, not permitted to enter 
the rectum. To this end, it is best not to attempt service in case 
of a mare not certainly in proper estrum. It is a part of the busi_ 
ness of the groom to see and to know that the penis of the stal. 
lion is properl}' entering the vulva of the mare. If the mare is 
kicking or otherwise violently resisting the stallion, he should be 
promptly withdrawn, since copulation under such circumstances 
is unwarrantedly dangerous for both animals. Such violent re- 
sistance of the mare is sometimes offered by the groom as an 
excuse for his failure to see and know that the penis of the 
stallion was being properljr entered in the vulva, but it is not 
valid. The mare or cow with retracted anus should be placed 
with her hind feet on a lower level than her anterior members, 
leaving the ground upon which the male is to stand at a higher 
level and thus bringing the vulvar opening more nearly perpen- 
dicular. In the cow and sow, the accident is not usually pre- 
ventable. 

The prognosis of penial injuries to the rectum must be based 
largely upon the position and extent of the injury. When the 
lacerations perforate the peritoneum and cause escape of feces 
into the peritoneal cavity the injury is essentially fatal, veteri- 



56 Veterinary Obstetrics 

narians having not yet succeeded in successfully handling such 
lesions. When the rupture of the rectal wall occurs behind 
the peritoneum or otherwise does not perforate it, the prognosis 
is good if timely surgical aid is given, though, after a long period 
of time, serious or fatal results maj' follow the impaction of feces 
in the sac formed in the pelvic connecting tissue. The pressure 
of the feces escaping from the rectum tends constantly to push 
the loose connective tissue aside and, eventually, to form a large 
sac, which is constantly filled with fecal masses. 

The handling in such cases consists of gently removing the 
feces from the sacculated wound cavity in the pelvic connective 
tissue and cautiously flushing it out at least twice daily with a 
mild antiseptic solution. At the same time, the rectum should 
be manually emptied as far as the attendant can reach and the feces 
thus prevented from dropping into the sac. The patient should 
be kept at rest on a very scant, laxative diet during the treatment, 
which should be continued until the rupture is quite healed as it 
is highly important to guard against extensive sacculation in the 
part, which can only be done by avoiding the accumulation of 
feces in it. 

In some instances, the injuries to the rectum from the entrance 
into it of the penis are comparatively trivial and consist merely 
of wounds of the mucosa and somewhat of the muscular walls, 
with the passage of bloody feces, some swelling about the anus 
and other slight S5miptoms of injury, which readily pass away 
under repeated antiseptic enemata. 

From a forensic standpoint, the owner of the stallion is probably 
always responsible for the damages to the mare, since the acci- 
dent is preventable with proper care upon the part of the groom. 
Such were the findings in the only case which we have seen tested 
in the courts. 

Harms, quoting Hinrichsen, mentions an instance in which a 
cow had her tail fractured at the base during copulation. 

The vagina, especially of the mare, is not infrequentlj' lacer- 
ated or ruptured by the penis of the male. The size of the penis 
of the stallion does not bear a constant ratio to the size of the 
body, but is comparatively excessive in coarsely bred animals 
with long legs and large heads. Such stallions, copulating with 
small mares, constantly tend to produce vaginal injuries. Some- 
times it is merely a slight laceration in the mucous membrane. 



Physical Injitries 57 

which may cause limited hemorrhage and some straining ; some- 
times the lacerations in the mucosa and muscular walls are ex- 
tensive and induce marked S3mitoms of wound infection in the 
vagina with tumefaction, discharge and straining ; while, in other 
cases, the vaginal walls are completely ruptured, with great dan- 
ger of fatal peritonitis. 

In one instance investigated by us a series of injuries was caused 
by a recently imported stallion, which had been put to service 
among comparative!}' small mares. Almost every mare served 
by him exhibited signs of vaginal injury ; some were severely 
lacerated; in one there was a fatal rupture. Inspecting the horse, 
he was found to be an overgrown, coarse, leggy grade draft stal- 
lion about eighteen hands high and with an enormous penis 
which would have been dangerous with heavy draft mares, while, 
in his neighborhood, most animals were of small roadster or com- 
mon stock. 

When such injuries occur, there is observed an abnormal amount 
of straining immediately after copulation, with, perhaps, some dis- 
charge of blood from the vulva. Later, swelling of the vulva and 
a muco-purulent discharge may occur. 

If the wound penetrates the peritoneal cavity, septic peritonitis 
is highly probable, with early collapse and death. 

Injuries to the mare from this cause should be obviated by 
means of a roll or padded surcingle encircling the body and pass- 
ing just in front of the sheath in a manner to prevent the penis 
from entering the vagina to its full length, the pad or roll being 
adjusted in size according to the case. The diameter of the roll 
should alwa3's be ample, since little fear need be entertained that 
the prevention of the entrance of the entire length of the penis 
will unfavorably affect the results of copulation, as general obser- 
vations show to the contrary. In constructing this roll or pad 
an ordinary surcingle may be used and a tube made of sheeting 
or other sufficiently strong material and this, open at each end, 
slipped over the surcingle. Padding of cotton, oakum or other 
material is then to be inserted into the tubular covering until it 
is tightly filled so that it presents a diameter of 4 to 8 inches 
in that part of the surcingle to come in contact with the abdomi- 
nal floor, after which the open ends of the tube are to be secured 
to the surcingle and closed by tying. When the stallion is 
ready for service, the surcingle is passed around his body just in 



58 Veterinary Obstetrics 

front of the opening of the sheath and secured by buckling. In 
copulation, only that portion of the penis projecting beyond 
the roll can enter the vagina. 

Non-fatal laceration of the vagina should be handled along 
general antiseptic lines, the practitioner remembering constantly 
that this organ reacts strongly to irritants and that thorough dis- 
infection should be brought about largely b}' mechanical flushing^ 
rather than by heroic attempts to destroy the micro-organisms 
in position. 

Lacerations of the vulvo- vaginal canal during copulation some- 
what rarely occur because of pathologic changes due to prior 
diseases, especially to adhesive inflammations leading to impor- 
tant stricture or occulusion. In one instance coming under 
observation, in a mare, there were old adhesions of the vaginal 
walls in their anterior portion. An attempt to breed her caused 
such injury as to lead to violent expulsive efforts, by which she 
iorced the urinary bladder, covered by the vulvo- vaginal floor.out 
through the vulvar opening — vesico-vaginocele — which persisted 
in spite of trusses, sutures and other expedients and was only 
controlled by producing prolonged and deep anaesthesia with 
chloral. 

In cows, adhesions of the vaginal parietes may occur as a result 
of infectious vaginitis and naturally render coition unsafe if not 
impossible. 

Lacerations of the vagina by the penis are also liable to occur 
in other domestic animals though less probable than in the mare. 
Their symptoms, prognosis and treatment are essentially the 
same. 

Duranton (Journal de Lyon, 1888) records a case in which the 
uterine cornu of a cow was ruptured about 3.5 cm. anterior to 
the OS uteri, supposedly by the penis of the bull during copula- 
lation. We consider the record open to question and would 
think it more probable that the rupture had occurred from other 
causes. 

Injuries to the bladder by the penis of the male have been 
recorded, though verj' rarely. Harms, quoting Nebele (Reper- 
torium) mentions one case in a cow in which the bladder was- 
ruptured owing to the entrance of the penis through the meatus 
urinarius. The probability of such an accident seems especially 
remote in the cow because of the small valve arising from the 



Physical Injuries 59 

floor of the meatus and extending forwards. In the mare, this 
accident would seem quite as possible because of the very wide, 
valveless meatus, through which several fingers may be passed, 
but the penis of the stallion is much larger and the glans very 
broad . 

In one instance, a somewhat coarse two-year filly, weighing 
1700 pounds was presented for service to a 2400 pound stallion 
with a large penis. Upon mounting her, the stallion entered his 
penis into the vulva a short distance, where an obstruction was 
apparently encountered, and after a time he dismounted. After 
repeated unsuccessful efforts the author was asked to examine 
her and found a persistent hymen across the lower portion of the 
vagina, sloping upward and backwards which had directed the 
penis downward against the meatus urinarius, through which the 
hand could be easily passed, but no injur}' from the penis could 
be detected at the time or later ; on the other hand when the 
penis encountered the obstruction, the stallion desisted from 
further attempts at copulation. 

Injuries to the female because of great weight of the male are 
not rare though far less common than one would be inclined to 
expect when the disparity in size is considered. It is not rare 
to .see females served b}' males two, three or more times their 
weight and yet escape injury entirely. In the smaller species of 
animal, like the pig and dog, the female can quite readily drop 
to the ground under excessive weight and escape injury, but, 
in the cow and mare there is danger of serious injury when 
the weight of the male becomes too great. Ordinarily, a cow 
or mare can readily withstand copulation with a male weighing 
150% more than herself, or a cow or heifer weighing 800 pounds 
can be safely bred to a bull weighing 2000 pounds or slightly 
more. When this point has been greatly exceeded, danger arises 
and increases in proportion to the variation in weight. In one 
instance a heifer of about five months and weighing about 400 
pounds was served by a bull weighing 2000 pounds and suf- 
fered a fracture of the pelvis, though not sufficiently serious to 
prevent her giving birth in due time to a calf from the service 
which caused the injury. In another instance, a sucking filly 
was ridden by a large stallion, causing dislocation of the sacro- 
iliac articulation on one side and fracture of the iliac shaft on 
the other, rendering her useless for labor and, after having been 



6o Veterinary Obstetrics 

bred at two years, necessiating her destruction at three years, 
because of irremediable dystokia. It is, therefore, desirable that 
j^oung females which come in estrum very early in life, should 
be securely segregated from mature males, not alone because of 
the undesirability of very early breeding, but in order to avoid 
serious injuries from disparity in size. It is also essential to 
remember that a male breeding animal regularly confined, in 
case of accidental escape, will attempt rape upon the most im- 
mature j'oung as in the foregoing case, with serious or fatal 
results. 

In the mare, injuries to the neck and withers are also liable to 
occur from bites by the stallion during coitus. This is probably 
most common among heavy draft stallions, some of which are 
very rough and cause more or less serious lacerations or contu- 
sions, at times leading to fistulous withers. There seems to be 
no means for breaking the stallion of the vice and the only ef- 
fective method of control with which we are acquainted is the 
application of a muzzle during coition. 

Injuries to the male because of over-size of the female also oc- 
cur, especially in the bull. When j'oung bulls of small size at- 
tempt copulation with mature or large cows, they are liable, at 
the moment of the violent copulatory thrust to take their feet 
off the ground to such a degree that in coming down they 
miss their footing, their hind feet glide forwards and they fall 
heavily backwards, sometimes causing fracture of the spine or 
other serious injury. It is to be avoided by guarding against too 
^reat a disparity in size and by placing the small male in as 
advantageous a position as possible both as to slope of ground 
and security of footing, especially avoiding damp, slipperj' ground. 

In one case brought to our attention a similar accident oc- 
curred to a cow, which being in heat, mounted one of her mates 
slipped, fell and fractured her spine so that she had to be de- 
stroyed. 

Injuries to the penis of the male during copulation are b}' no 
rare. The penis of the stallion is most liable to injur}' from kicks 
by the mare, the avoidance of which we have considered above 
while discussing the subject in a general way. These contusions 
of the penis during its great vascularity in the breeding season 
are very difficult and refractory to handle. The stallion needs be 
kept quiet, free from sexual excitement, the penis retained at 



Physical Injuries 6i 

rest within the sheath by means of a suspensoritim and the re- 
sulting local inflamation ameliorated by the application of cool- 
ing astringents such as lead acetate, hamamelis, tannin, bella- 
donna, etc., combined in cases of necessity with antiseptics. Gen- 
erally the patient may have quiet walking exercise, a restricted 
laxative diet, saline laxatives or in case of serious disturbance, 
prompt cathartics of the hypodermic alkaloidal group. 

Lesser injuries to the penis of the stallion are caused by the 
pushing of tail hairs of the mare into the vagina by the glans 
penis. These being drawn tightly across the penis, cut the organ. 
This is to be prevented by the stallion groom by drawing the tail 
of the mare aside at the commencement of the copulatory act or 
better by means of a bandage about the base of the tail extending 
low enough to secure any hairs that might be caught upon the 
glans penis or by braiding the upper hairs of the tail upon the 
dorsal surface. 

In bulls and other male ruminants, the penis occasionally be- 
comes caught against the side of the vulva or elsewhere and the 
animal at the moment of making the violent copulatory thrust, 
doubles the organ sharpl}^ upon itself, "breaking" it or other- 
wise causing serious injury. Sudden and violent bending of the 
erected penis causes such injuries to its tissues that the "broken" 
organ remains curved or bent at an angle, or that portion beyond 
the point of injury does not become erected, which renders him 
useless as a breeder (see Sterility) or the injurj^ causes balanitis 
or inflammation of the prepuce which leads to adhesions so that 
the organ cannot be protruded. 

The prevention of such injuries is more important and practica- 
ble than their handling. They are most liable to occur in 
confined males which are suddenly brought in contact with fe- 
males in estrum, not always in a proper state for coition. The 
female ma}' be nervous or timid at the approach of a strange male 
or, still worse, estrum may not yet have reached its fullness or has 
begun to decline so that she will not stand well and, as a result 
of resistance, the accident may occur. Slippery or uneven ground 
may also render the act insecure and lead to injuries to the penis. 

Prevention should be based chiefly on the avoidance of these 
and other dangers. In cows especially, it is important that they 
be properly in estrum, that the enclosure in which copulation is 
to occur is reasonably even and the footing secure. Zschokke 



62 Veteri7iary Obstetrics 

commends (Der Unfruchtharkeit des Rindes, Page 66) service 
stocks consisting of five posts upon which are fixed two beams 
which meet in front to constitute an acute triangle, open at the 
base, into which the cow is led and from which she can not 
readily escape or make any extensive movements. 

In the handling of such injuries to the penis, little can be done 
beyond the allaying of infection by means of anteseptic douches 
and the avoidance of sexual excitement, combined with such lo- 
cal and general treatment as would tend to control inflammation. 

In the dog, in which, during copulation, the prominent glans 
penis becomes tightl)' fixed in the vulva of the bitch, the male 
may dismount and turn in the opposite direction thus bending 
the penis abruptly. If disturbed by other dogs or in any other 
manner, violent dragging upon the penis follows, which leads to 
injuries of a more or less serious character, chiefly to swelling 
and inflamation of the parts, occasionally accompanied by para- 
phymosis. These injuries are not usually observed under proper 
breeding arrangements but are generally seen where bitches are 
permitted to run at large and a large number of dogs to congre- 
gate, with the resultant fighting. 

The handling of such injuries to dogs consists of essentially the 
same methods as in the bull, chiefly of disinfection. If para- 
phymosis results, it should be overcome. A solution of eucaine, 
with perhaps some adrenalin, may be applied to the swollen glans 
penis, after which, by the application of digital compression orbj' 
means of an elastic bandage, the size of the congested organ may 
be so reduced that it can be pressed back into the prepuce. If 
not, the margin of the prepuce is to be enlarged bj' incision suffi- 
cienth' to permit the penis to return. 

Copulation is one of the most common causes of strangulated 
inguinal hernia in the stallion and the accident is occasionally 
induced in this way in other male animals. When the stallion 
mounts the mare, his position subjects the inguinal region to 
increased pressure from the weight of the abdominal viscera, the 
position of the abdomen having been changed from horizontal, or 
a declination downwards and forwards from the inguinal ring 
towards the diaphragm, to almost the perpendicular, with the 
entire weight of the abdominal viscera pressing downwards upon 
the pelvic inlet and inguinal opening. The pressure is further 
augmented by the abdomen of the stallion becoming forcibly com- 



Physical hijuries 63 

pressed against the buttocks of the mare, as well as by the vigor- 
ous contraction of the abdominal muscles during the act and all 
combine to increase the intra-abdominal pressure and tend to 
force a small section of intestine through the inguinal ring, where 
it quickly becomes strangulated unless it promptl)' returns to its 
proper position when the stallion dismounts. 

In such case, soon after dismounting, in 15 to 30 minutes, or 
even earlier, the stallion exhibits symptoms of colic, kicks at his 
belly, looks at his flank, breathes rapidly, sweats profusely and 
rolls violently. 

The agony is excruciating and constant, increasing in intensity, 
the sweat becoming more profuse until, after ten to twelve hours 
in very acute and unrelieved cases, the violence abates, the body 
surface, bedewed with sweat, becomes cold, the pulse rapid and 
weak or imperceptible, indicating gangrene of the incarcerated 
bowel, to be soon followed by death. 

If the inguinal region is carefully examined a tense fluctuating 
swelling may be recognized, but, in many cases, the incarcerated 
intestinal loop is so small that its presence can be determined 
only by very careful palpation. Examination per rectum 
usually gives more definite results, and the incarcerated intestine 
can be felt and grasped, making the diagnosis definite and final. 

The handling needs be prompt and usually radical, if the life 
of the patient is to be saved, -although spontaneous recovery 
occurs in some cases. If the agony of the patient does not pro- 
hibit the attempt, the operator may insert his hand per rectum 
and grasping the incarcerated intestine, drag gently and cau- 
tiously upon it and thus attempt its replacement. At times this 
succeeds. 

Should this fail, the animal is to be cast in dorsal recumbency 
with the hind legs sharply abducted and the inguinal region 
freely opened. The dragging on the incarcerated bowel per 
rectum may now be repeated, accompanied by digital manipula- 
tion or compression externally with the other hand or by an 
assistant. If the hernia is not promptly reduced, chloroform 
anaesthesia should be induced, which further relaxes the parts, 
and replacement may yet succeed. 

Failing in these efforts, herniotomy should be performed with 
the least possible delay. After thorough disinfection of the re- 
gion, proper sterilization of hands and instruments, and covering 



64 Veteri?iary Obstetrics 

the adjacent parts, including the hind feet and legs, with aseptic or 
antiseptic towels or napkins, the scrotum is to be freely and cau- 
tiouslj' incised down to the incarcerated intestine, after which the 
carefully disinfected and moistened index finger is to be passed 
up along the anterior side of the herniated bowel to the point of 
incarceration in the internal ring. Using the finger as a guide, a 
herniotome, probe pointed bistoury, scalpel, or such other instru- 
ment as the exigencies of the situation afford, is introduced 
through the ring at its antero-external angle and the tissues are 
suificiently divided in a direction forwards and outwards to per- 
mit the incarcerated intestine to return. Sterile or antiseptic 
gauze is then introduced into the wound and packed closely 
against the internal ring in a manner to avoid all danger of a re- 
currence of the hernia and the scrotal wound is closed by sutures. 
The tampon may be omitted and deep sutures taken in the inter- 
nal ring, closing it against future hernia. 

Twenty- four to forty-eight hours later the antiseptic gauze may 
be removed, the wound disinfected and closed and thereafter left 
undisturbed or handled according to indications. 

2. General Infections of Coition. 

Coition brings the involved animals into such intimate contact 
that it offers special facilities for the transmission of infectious 
disorders from one to the other, regardless of the natural avenue 
of entrance of the microorganism. In their sexual maraudings 
animals make close approach to each individual of their species 
with which they meet and thereby tend to contract any conta- 
gion which may be extant in the neighborhood or, having such 
disease, to distribute it everywhere in its path. Thus, the author 
recalls an instance of a boar pig, wandering from the farm, to re- 
turn later and, sickening from hog cholera, spread the malady 
to the entire herd, causing the death of more than 100 animals. 

The dangers are little less at times among breeding animals 
kept confined. A young foal with strangles accompanies its 
dam to the breeding place, scatters the infection about the prem- 
ises where other colts may later come in contact with it or the 
stallion, being young and non-immune, contracts the disorder and 
transmits it to susceptible animals coming in contact with him, 
thus disseminating the infection pver a wide area. Bierstadt 
(Woch, fur Thierheilkunde) records the transmission of stran- 



Physical Inju7'ies 65 

gles by a supposedlj' convalescent stallion to mares, apparently- 
through the genital canal, as abcesses formed in the pelvis about 
the rectum and vagina. While abcesses occur in these parts 
from the usual mode of infection, the observations of B. are 
highly significant and interesting. 

In the infections cellulitis or ' ' pink eye ' ' of the horse (see page 
68) with the prevailing orchitis in the stallion, the malady is 
very liable to be transmitted through coition. In contagious 
abortion, coition is quite generally regarded as one of the most 
fruitful sources of dissemination, it being assumed that the spe- 
cific microorganism is carried directly into its native habitat and 
most favorable position for growth, upon the penis of the bull. 
In one instance the author has seen actinomycosis of the uterus 
and broad ligaments of a cow, resulting in her sterility, without 
other discoverable actinomycotic lesions, which suggested the 
probability of the infection having been lodged in the genital 
canal by copulation. The dissemination of general contagions 
through sexual contact applies especially to males kept for gen- 
eral breeding service and serving females coming from a wide 
area ; the arrival of females from so many different points tends 
to carry any contagion to the breeding place, thence to be dis- 
seminated by him to every part of the territory involved. 

If a healthy male escapes from an enclosure, wanders from home 
and contracts a disease, he carries it back and exposes the other 
animals of his species ; if diseased and he wanders into a neigh- 
boring healthy group of breeding animals, he carries the infec- 
tion to them. Similarly a female, especially when in estrum, may 
prove an important disseminator of contagion. 

It is, therefore, well to consider the breeding place as one of 
the most important of distributing points for contagious diseases 
of animals and the veterinarian should constantly regard it as 
such and be in a position to direct capably how the dangers may 
be reduced to a minimum. When a breeder has an adequate 
number of females to warrant the keeping of a breeding male 
of the desired quality for his own use, it is good economj' to do 
so, to breed all his females to the one male and to accept no 
females from outside for breeding. This is only rarely practi- 
cable. When breeding males are kept for public service, the 
females offered for breeding should be rigidly scrutinized . Not only 
5 



66 Veterinary Obstetrics 

should they show no sign of disease but they should come from 
a herd where no contagion is known or believed to exist. The 
manager of public breeding animals should keep himself thor- 
oughly posted upon the prevalence of infectious diseases in his 
area and should carefully investigate any reported appearance of 
such diseases. When infectious maladies appear in the com- 
munity he should ascertain as clearly as possible the extent of 
dissemination, the location of each center of infection, and then 
take such measures as are necessary to prevent the contraction of 
the disease by the breeding male or his transmitting it to other 
females. Here the general rules of disinfection should be rigidly 
carried out and, if necessary, isolation and the suspension of 
breeding be applied. The exclusion from the breeding pen or 
place of males, females or suckling young affected with con- 
tagious diseases, however mild or convalescent, should be rigid- 
ly enforced, the place should be kept clean, disinfected if con- 
ditions suggest, and, whenever warranted (perhaps it always is), 
the penis and prepuce of the male should be disinfected before or 
after each service. This is a matter of but a few moments if prop- 
er conveniences are arranged and would frequently avoid seri- 
ous outbreaks of contagious disease. 

The arrangements for the disinfection of the genitals of male 
breeding animals should be simple and thoroughly convenient 
and effective. A pail or other vessel of copper, galvanized 
iron or tin fitted with lid and bail and having a capacity of one 
to two and one half gallons will readily serve the purpose. At or 
near the bottom of this vessel have inserted a small horizontal tube, 
curved downward at the external end, over which the end of a 
piece of rubber tubing six to ten feet long is slipped and secured. 
After the disinfecting solution is placed in the vessel, the latter 
is to be elevated by means of a cord attached to the bail and 
passing over a pulley or beam, until a sufficient height is reached 
to supply the desired force by gravity. Usually a height of three 
to six feet above the part to be treated suffices. The distal end 
of the tube may then be inserted into the sheath of the penis, 
the opening of the sheath grasped and held closed for a time and 
the entire cavity distended with the antiseptic fluid ; or the tube 
may be pushed far back to the posterior end of the sheath and 
the current of antiseptic fluid be depended upon to reach every 
part. 



General hifedwis of Coitio7i 67 

Another very simple method for flushing out the penial sheath 
is to use an ordinary pure gum horse catheter for a tube, its 
rounded distal end offering an ideal shape for introduction into 
sheath, while a small funnel, inserted into the other end, affords 
facility for pouring the antiseptic fluid through the tube into the 
sheath and the funnel, held as high as the length of the catheter 
will permit, affords sufficient force of gravity for the purpose de- 
sired. The entire apparatus is cheap, compact, withstands steri- 
lization by boiling and is efficient. 

Any reliable disinfectant will answer the requirements but 
those which tend to dissolve, or are miscible with fats are best, 
especially about the preputial opening and the surrounding skin. 
Among these, lysol and carbolic acid take a high place. The 
antiseptic solutions should preferably be used warm and, in dis- 
infecting the skin adjacent to the preputial opening, soap should 
be added. The strength of the disinfectant introduced into the 
sheath should not be great, ^ to i % of lysol or carbolic acid 
being as strong as the naked mucosa of the penis, especially of 
the bull, will readily tolerate. 



CONTAGIOUS CELLULITIS. EPIZOOTIC CELLULITIS. 

PINK EYE. RHEUMATIC INFLUENZA. 

MUCO-ENTERITIS 

Bibliography — Williams, Epizootic Cellulitis ; Principles and Practice 
of Veterinary Medicine, 4th edition, 1888, p. 251. Cave, Pink Eye: Vet- 
erinary Journal, 1S83, Vol. XVI, p. 336. Whitworth, Pink Eye Disease ; 
ibid, 1883, Vol. XVII, p. 153. Pottie, Jour. Comp. Path. andTherap., Vol. 
I, p. 37. Clark, ibid. Vol. V, p. 261. Reeks, The Transmission of Pink 
Eye from Apparently Healthy Stallions to Mares ; ibid., Vol. XIV, p. 159 
and Vol. XV, p. 97. 

Contagious Cellulitis is a highly contagious acute fever of the 
horse, which has been generally ignored except by British veter- 
inary writers, although it seems to be widely distributed in vari- 
ous countries. It is common in parts of America, but fre- 
quently confused with influenza or catarrhal fever, although 
wholly distinct. 

We insert an account of this disease here because of its inti- 
mate bearing upon the question of horse breeding, which it affects 
chiefly in three distinct ways. 

It is frequently spread from apparently healthy stallions to 
mares through copulation, in which respect it approaches the 
character of a venereal disease, although, as a general rule, this is 
not the method by which it is transmitted from animal to animal. 

It has a relation to sterility because it causes an orchitis in 
the stallion, which frequently leads to a permanent loss of func- 
tion in these glands. 

It is related to abortion in that it very frequently causes the 
death of the fetus in utero when affecting the pregnant mare. 

Symptoms. The symptoms of the disease consist primarily of 
an elevation of temperature, sometimes accompanied by chills, 
dullness and other phenomena, which belong in general to acute 
contagious fevers. The fever appears very suddenly, usually 
ranging from 103 to 105° F. although it may exceed this. Gen- 
erally speaking, the temperature is higher than in influenza and 
lower than in the contagious pneumonia of the horse. The 
pulse is hard and full and somewhat quickened, while the res- 
piration is not very greatly disturbed. Some cough is present, 
though this does not constitute a very'prominent symptom of 
the affection. 
68 



Cojitagious Cellulitis 69 

Early in the disease there is a manifestation of pain in the 
limbs, which is shown by shifting of the weight from one foot to 
another while the animal is standing and by great stiffness and 
soreness when forced to move, the movements being accompan- 
ied by a cracking sound in the joints. After a time the legs be- 
gin to swell, commencing at the feet and extending upward until 
at times it reaches the body. This tumefaction has its chief 
seat in the subcutaneous connective tissue and is at times very 
great. As the swelling of the limbs increases, the pain in them 
tends to abate and at the same time the fever begins to decrease. 

The alimentary tract is greatly disturbed, there being a very 
marked tendency to constipation at first, in which the feces are 
covered with large quantities of mucus and their color considera- 
bly altered. Defecation causes some pain and straining. I^ater 
there is a tendency to diarrhoea, which is easily and often fatally 
intensified b}^ the administration of purgatives, especially of 
aloes. The conjunctiva is markedly altered in color, becoming a 
bright, pink hue, swollen and edematous. At times the con- 
junctivae are so badly swollen that the eyelids become somewhat 
everted and the edematous membrane pushed out between them. 
The eyes are very sensitive to light and the animal attempts to 
keep them closed. There is a profuse secretion of tears, which 
flow down over the cheeks. The cornea is frequently clouded 
so that vision may for a time be interrupted. There is some 
tendency toward pleurisy, pneumonia and other pulmonary 
complications. 

From an obstetric standpoint, the chief interest lies in the 
complications of the genital organs. In our experience, the 
breeding stallion shows a great tendency to suffer from orchitis. 
We have seen in large importing stables 50 to 75% of the stall- 
ions attacked with pink eye suffering from inflammation of the 
testicles. Along with the swelling of the scrotum and sheath, 
which accompanies that of the legs, there usually appears a 
tense, painful enlargement of the testicles, which tends to persist 
for a considerable period after the general symptoms of the dis- 
ease have largely disappeared. In some instances we have seen 
permanent sterility result so that the breeding value of the 
stallion was completely destroyed. 

In other cases we have noted that stallions apparently re- 
covered from the disease have quite uniformly transmitted it, 



yo Veterinary Obstetrics 

during copulation, to susceptible mares. These observations are 
entirely in harmony with those of Reeks, who records an instance 
where an apparently sound stallion transmitted the disease to 
susceptible mares almost uniformly over a period of two years. 
This observation is a not uncommon experience. 

It is notable also that, when the disease attacks a pregnant mare 
it generally causes abortion or, if attacking her just prior to 
parturition, the living foal is likely to succumb within a few days 
after birth. Reeks, recording an outbreak under his charge, re- 
lates that four pregnant mares, or mares which had just foaled, 
contracted the disease. Two of the pregnant mares aborted, and 
the foals of the other two died suddenly shortly after birth. In 
our experience, in an extensive horse breeding district, the dis- 
ease quite uniformly leads to abortion in pregnant mares. 

Although highly contagious, the affection is of short duration, 
usuallj^ runs a favorable course, in from four to six days, and 
leaves the animal but little altered, except in those used for 
breeding. The eyes also may become permanently weakened 
and invite later attacks of disease. In some unfavorable cases 
the pulse becomes weak and there is a general depression, which 
is liable to be followed by sudden death owing, it appears, to heart 
failure, in which case there are usually found large thrombi in 
the cardiac cavities. 

No specific treatment has been discovered. In our experience 
the greatest benefit is to be derived from the administration of 
diffusible stimulants, like nitrous ether or carbonate of ammonia, 
along with quinine. Purgatives are to be avoided, aloes being 
especially dangerous. The bland oils might be used in some 
cases as aperients, or very small doses of eserine, arecoline or 
other alkaloid hypodermic cathartic, taking care to make the 
dose sufficient!}' small to induce no harmful degree of excite- 
ment and barely sufficient to induce gentle purgation. There is 
naturally much divergence of opinion among veterinarians in 
reference to the treatment of this affection, but in its general 
handling we are not specially interested. 

From an obstetric standpoint, we are chiefly concerned in the 
question of the spread of the malady from the breeding pen and 
its tendency to induce sterility and abortion. 

When the disease appears in a breeding area it should be han- 
dled with the greatest rigor as to quarantine, and breeding quar- 



Contagiojis Cellulitis 71 

ters should receive special consideration. Diseased mares or 
mares coming from infected premises should on no account be 
admitted to the breeding place. Should the malady become gen- 
eral in a neighborhood, as it usually does when an outbreak oc- 
curs, breeding should be suspended until the disease is extermin- 
nated. 

When a breeding stallion has become infected, aside from the 
general handling of the malady, special attention should be given 
to reducing to a minimum the dangers from orchitis and later, 
after the acute symptoms have passed, to overcoming the linger- 
ing chronic infection, through which he may continue to spread 
the disease to mares. 

When it is known that a non-immune breeding stallion has 
been exposed to this disease, immediate precautions should be 
taken to guard the animal against a severe attack. He needs be 
placed at rest, physically and .sexually. The usual high feeding 
of breeding stallions should at once be displaced by a very light 
laxative diet, such as grass, roots and bran, with an abtmdance of 
salt. If these measures do not induce a prompt unloading of 
the alimentary tract the bowels should be evacuated by means 
of small doses of eserine or arecoline and the system placed in 
first class condition to withstand the onset of the disease. Pend- 
ing the advent of the disease, the animal should have regular daily 
exercise, great care being taken, however, not to continue it 
after the advent of the first symptom of the malady, fever, 
has become established, as indicated by thermometry. At- 
tacked without these precautions, similar measures should still 
be adopted, the ration reduced and confined to laxative foods, 
while the bowels are promptly and cautiously evacuated. 

The patient is to be guarded jealously against physical or 
sexual excitement. Strange mares should not be allowed in 
sight or hearing, and every precaution should be taken against 
arousing sexual desire. In most stallions the application of 
the stud bridle occasions excitement, which, at such times, 
should be avoided. 

If orchitis appears, as it frequently does, in addition to the 
foregoing measures, including the internal administration of 
nitrous ether and quinine, local applications to control the in- 
flammation in the glands should be applied. First among these 
in the early stages is local refrigeration by the application of cold 



72 Veterinary Obstetrics 

water or ice. Probably the most efficient means is the applica- 
tion of broken ice by means of a suspensorium, which serves the 
double purpose of refrigeration and supporting the weight of the 
pendant glands. This treatment should be constantly and faith- 
fully applied until the crisis of the malady has passed, since the 
effective handling of these glands may determine whether the ani- 
mal is to be of further value as a breeder or not. Such remedies 
as belladonna and camphor, applied locally, tend to relieve con- 
gestion and overcome the inflammation, but, in a critical case we 
believe the refrigeration superior. 

lyater, when the acute symptoms have passed, chronic infection 
should be considered, precautions taken against the spread of the 
malady to mares and measures adopted to eradicate the infection 
from the system as quickly as possible. 

P'or this purpose an extended course of potassium iodide at 
the rate of Y-z ounce per daj^ for each i,ooolbs. of body weight is, 
in our judgment, the safest remedy. B}' some veterinarians, fears 
are entertained that the prolonged administration of this drug 
may induce a harmful atrophy of the testicles, but we consider 
this quite imaginary and without foundation. We would con- 
tinue the drug for three or four weeks, or longer if necessary. 

Abundant time should be allowed to elapse, after the disappear- 
ance of all visible symptoms of the disease, before permitting the 
animal to serve mares. It is advisable, in case the disease attacks 
the stallion during the breeding season, to withdraw him from 
the stud for the year. In any case it is wise to begin breeding 
cautiously and watch closely for evidences of the transmission of 
the infection to susceptible mares. When a stallion which has 
sufferedjfrom pink eye shows evidences of sterility, careful examin- 
ation of the genitals and of the semen should be made and, should 
any restoration of the breeding powers seem possible, appropriate 
measures undertaken but usually, in our observation, the sterility 
following pink eye is permanent and irremediable and the animal 
must be removed from the stud and, with or without castration, 
used as a work hor.se. 



SPECIFIC INFECTIONS OF COITION 
Venereal Diseases. 

Venereal diseases have been described in nearly, if not all of 
our domesticated animals, especially in horses, cattle, sheep and 
dogs, with briefer references in our literature to such diseases in 
goats, swine and rabbits. In horses we recognize two well defined 
venereal affections, Doui-me or Maladie du Co'it and the Eruptive 
Venereal Disease or Genital Horse Pox ; in cattle the Vesicular 
Venereal Disease and the Infectious Granular Venereal Disease ; 
in the dog the Veiiereal Granulomata ; and in sheep an Ulcerative 
Venereal affection. 

I. DouRiNE OR Maladie du Coit. Beschalseuche. 
Equine Syphilis. 

Bibliography. Baldrej' ; Jour. Comp. Path. andTherap., 1905, Vol. 18, 
p. 7 ; de Does, Jahresbericht, 1902. Hutyra und Marek ; Spezielle Pathol- 
ogic and Therapie. Thanhoffer ; Ueber Zuchtlahme. W. L. Williams ; 
Report Illionois State Board of Live Stock Commissioners, 18S7. 

Dourine of the horse is the most serious venereal disease known 
among domestic animals, both on account of its wide geograpical 
distribution and the mortality and loss caused by it. It is widely 
dissemminated in Europe, Asia, Africa and North America. It 
has been recognized for more that a century and has appeared in 
all the leading countries on the European continent. In English 
speaking countries, it was first recognized by the author at Wa- 
pella in DeWitt County, Illinois, in the spring of 1886 among 
imported French draft stallions and the mares which had been 
served by them. The disease in Illinois apparently broke out 
in 1884 or 1885, but its nature was not determined until 1886 and 
even then its seriousness was not fully appreciated so that it was 
not until 1887 that vigorous measures were undertaken for its 
control and eradication. In the meantime, numerous animals had 
been sold from the infected area and widely disseminated over 
the country in a manner which made it impracticable to effect- 
ively trace them to their ultimate destination. When the im- 
portance of the malady became recognized it was promptly placed 
under control and was so completely eradicated that up to the 
73 



74 Veterinary Obstetrics 

present time, a period of tweiit}^ years, it has not reappeared in 
that territory. 

Since that time the affection has been recognized in Nebraska, 
South Dakota, and in the province of Alberta, Canada. In these 
areas of infection the disease has not been definitely traced to its 
source. The outbreak in Illinois was believed to have been in- 
troduced by stallions imported from France, a conclusion which, 
although unproven, time has not served to change. The affected 
area in Illinois produced considerable numbers of grade draft 
stallions and mares, which were sold to go to the West and North- 
west for breeding purposes, and, although it cannot be clearly 
shown, there is good reason to conclude that this outbreak furn- 
ished the infection for the others which have occurred in Amer- 
ica. 

It has now become so widely disseminated, its eradication from 
among range animals is so uncertain, and the possibility of fresh 
importation so apparent, that the malady is of great importance 
to the horse breeding industry of America, since it maj% possi- 
bly, manifest itself at an}' time in any breeding district. These 
facts render it important that veterinary practitioners, in horse 
breeding districts, should be on the alert and ready to recognize 
the disease in the early stages of an outbreak, ere it gains a wide 
distribution and its eradication is rendered difficult and uncertain. 

Nature. Dourine is a highly infectious venereal disease trans- 
mitted naturally by coition only. Experimentally, it may be trans- 
mitted by innoculation and to other animals than solipeds. It is 
due to a protozoan parasite belonging to the trypanosoma group. 
This parasite, the trypanosomum equiperdum, was discovered by 
Rouget in 1896 and its relation to the disease clearl}' demonstrated 
by Schneidei and Buffard in 1899. The trypanosome of Dourine 
is a one-celled organism provided with a flagellum at the anterior 
end. It is about 18 to 26 microns in length and, when observed 
in the living state, is highly motile. It occurs in the blood, spinal 
fluid, the discharges from the genital organs, in the plaques of 
the skin and perhaps in other tissues and fluids of the infected 
animal. It multiplies by longitudinal division. When removed 
from an animal and kept moist, it will live for several daj's or 
even a week. 

It is not always easily found. It is said to be most readily dis- 



Dourine 75 

covered in recently formed plaques. Baldrey says, in reference to 
the appearance of the trypanosoma in the fresh plaques, ' ' If these 
appear, then a positive diagnosis can be made ; if not, the case 
is not Dourine." The parasites are said to disappear quickly 
from these plaques, so that it is dificult or impossible to find them 
after twenty-four hours. They may be found in the discharges 
from tl.e vagina or urethra of the infected animal, but it seems 
that their existence here is not so uniform as in the fresh plaques. 
Some investigators believe that they are quite uniformly present 
in the spinal fluid. It is frequently very difficult to discover 
them in the blood. 

This parasite constitutes an exception to the general rule in 
the tr5'panosomic group of diseases, in that it is not transmitted 
from animal to animal by the bite of an insect. For laboratory 
uses it is generally cultivated in dogs. 

Symptoms. The period of incubation following natural in- 
fection is not definitely determined and varies considerably in 
different cases. Generally there appear some physical signs of 
disease in from eight to ten days after exposure, but these may 
not be very marked and may pass unnoticed by an inexperienced 
observer. 

The symptoms of the disease may be divided into three im- 
portant groups ; the local lesions of the genital organs and the 
contiguous parts ; those of the .skin and other mucous mem- 
branes than that of the genital organs ; and the symptoms which 
emanate from the central nervous system. 

The local symptoms in the genital organs are the first to 
appear after infection and usually the last to disappear in case of 
recovery. 

In the stallion there usually appears after eight or ten days, 
subsequent to infection, a swelling of the penis and prepuce, with 
some degree of protrusion of the penis from the sheath, still 
covered by the prepuce. The prepuce shows a tense, elastic 
swelling and has a smooth, glistening appearance. If the uretha 
is exposed to view, its meatus will be found swollen, dark red 
and intensely injected. From it exudes a small amount of a 
thin, dirty, muco-purulent discharge. As the disease progresses, 
the tumefaction of the prepuce and penis increases and extends 
to the sheath and scrotum, which may. eventually become enorm- 
ously swollen and remain in an indurated condition for one to 



76 



Veterinary Obstetrics 



two years or more. The animal gradually becomes less able to 
retain the penis in its position, and the swollen organ protrudes 
farther and farther out of the sheath, sometimes extending en- 
tirely out of the prepuce and hanging flaccid and fully exposed. 
The discharge from the urethra ma}' become somewhat ichorous 
and, with the general, soiled condition of the penis and surround- 
ing parts, may lead to ulcerations or erosions upon these. Later 
in the course of the disease, the weakened condition of the 
tissues of the part may lead to purulent infection and the forma- 




FlG. 7. DOURINE. 

Arab ponv at beginning of the second stage of the malady, show- 
chiefly the enormously swojlen sheath and penis and depressed as- 
pect of the patient. ( Baldrey. ) 



Dourine 



77 



tion of abscesses in the sheath, scrotum and inguinal region. 
(See Figs. 7 and 8). 

The testicles may undergo inflammation and swelling, which 
after a time may be followed by atrophy, and they may be pushed 
upward by the swelling or abscesses in the scrotum until they 
rest high up in the inguinal space, where they can not be readily 
felt. No vesicles or pustules occur upon the genitals as an essential 
part of this disease, but there occurs with considerable uniformity 
a depigmentation of the skin and covering of the penis so that it 
may largely lose its pigment and become white. This depig- 
mentation begins upon the penis and may extend to the prepuce 
sheath and scrotum. In studying this symptom, it is well to 
bear in mind that in gray horses and in those having white eyes, 
faces or feet it is quite common to observe an absence of pigment 




Fig. S. Dourine in Final Stage. 

English Thoroughbred stallion showing paralysis and edema of 
penis. (BaUhey.) 



78 Vetermarv Obstetrics 

on the penis, but this is regular in outline, whereas in dourine 
the depigmentation spreads out in patches. 

In the mare, about eight to ten days after infection there ap- 
pears a well marked swelling of the lips of the vulva. The 
mucous membrane of the vulva and vagina is intensely injected 
and swollen and from the vulva there escapes a more or less pro- 
fuse discharge of a mucous or muco-purulent character, which 
soils the tail and surrounding parts. The mare urinates fre- 
quently in small quantities, which causes pain, as indicated by 
straining, stamping with the feet and switching of the tail. 

There seems to be an increased sexual excitement, which ma}- 
be, to some degree, misleading, depending largely for its expres- 
sion upon the frequent urination, rather than upon genuine sex- 
ual desire. 

As the disease progresses, the volume of the discharge tends 
to increase, in some cases, assumes a dirty grajdsh character and 
may become fetid. The swelling of the vulva increases, the la- 
bise become much enlarged, are tense, elastic and glistening. 
Their margins stand somewhat apart, so that the vulva is partly 
open, especially at its lower commisure. 

Within a few weeks ^ after the advent of the disease, there appears 
quite regularly , a characteristic loss of pigment in the skin of the 
vulva and the ?ieighboring parts. This depigmentation begins 
along the margins of the vulva, without prior vesicular or pustular 
eruptions, as simple, white patches, and thence extends onward in 
irregular lines, or spots, until it may involve the entire vulva, 
perineum and anus. The white patch, or patches, have irregu- 
lar borders and are of various shapes and sizes. They persist for 
several months, and, in case of the recovery of the animal, they 
tend, finally, to disappear ; fading first at the periphery, while 
upon the margins of the vulvar lips they persist for six months 
or a year. (See Fig. 9). 

Of even greater significance, are the changes which occur in 
the clitoris. Comparatively early in the course of the disease, 
this organ becomes swollen, and, the vulva being somewhat 
open at the inferior commissure, it becomes visible, ordinarily, 
without mechanically parting the labise. The secretion of sebum 
in the prepuce of the clitoris apparently ceases, and the swollen 
organ seems dry and glistening. Depigmentation of the clitoris 
and its prepuce occurs early and persists for one to two years 



Dourine 



79 



in those mares which apparently recover and is the last symp- 
tom, in our experience, to disappear. The swollen, depigmented 
■clitoris, with gaping vulva, constitutes one of the most uniform 
and persistent symptoms of the malady, and gives to a young 
mare the appearance of extreme old age, in this part. 

Following closely upon the first appearance of local lesions, 
within a few weeks after infection, there appear peculiar and 
pathognomonic cutaneous eruptions in the form of placques, 




Fig. 9. Dourine in Mare. 

Depigmented spots on labise vulvae and extreme emaciation. 
(Hutyra and Marek. ) 



8o Veterinary Obstetrics 

elliptical elevations or " talerfiecke." These eruptions appear 
suddenlj', largely about the flanks, neck, shoulders, sides and 
thighs as more or less circular elevations, one to several inches 
in diameter. The margins of these are very abrupt and stand 
up above the level of the healthy skin like the eruptions of urti- 
caria, the hairs upon them being erect. They appear suddenly, 
not, usually, in great numbers, but only one to five or six at a 
time, remain a few days and disappear without leaving a mark, 
to be succeeded by a new crop. It is claimed that, in these 
placques, the trypanosomes are very abundant during the first 
stages of their existence, but as the eruptions grow old the para- 
sites rapidly disappear from them. 

It has been stated that these placques may cause intense itch- 
ing aud lead the animal to bite or rub the part and that they 
sometimes suppurate. None of these symptoms have been 
observed by us. 

It is not uncommon to observe in the latter stages of the dis- 
ease a more or less profuse discharge from the nostrils. This 
nasal discharge may in some cases be suggestive of glanders and 
superficial ulceration of the mucous membrane may rarely be 
present. These erosions, when present, have no specific charac- 
ter in appearance and suggest rather a necrosis of a greatly de- 
bilitated tissue as the result of an irritant applied externally. It 
must not be forgotten that glanders aud dourine may coexist 
and that the latter would, naturally, greatly intensify the former. 

The general debility' or cachexia of the disease shows itself 
clearly in lesions of the skin. Any wound of the part heals 
tardily and, if the animal is so weak that it is recumbent a large 
part of its time, it suffers from extensive decubitis gangrene. 

The symptoms, which are largely referable to the nerv- 
ous system, appear at about the same time as the placques or not 
long afterward. The first and most pronounced of this group is 
usually a progressive paresis, which is chiefly observable in the 
hinder parts. At first there is an unsteady gait, the animal bring- 
ing the hind feet forward in a difficult and somewhat uncertain 
manner. There is a tendency to drag the toe along the ground 
or to strike it at the middle of the stride. When weight is 
placed upon the foot the toe is usually brought down first, with 
the fetlock flexed, and the heel is then lowered suddenly. While 
standing, there is a tendency for the fetlocks to be maintained in 



Do urine 8.1 

a flexed position or somewhat knuckled over. This knuckling 
over, whether standing or during progression, is a rather common 
symptom in trypanosomic, if not protozoan diseases generally. 

This imperfect control may appear in one or both hind limbs 
or may alternate between the two and is subject to great varia- 
tion from day to day. Sometimes this partial paralysis is of a 
somewhat spasmodic nature, faintly resembling stringhalt. At 
times there may be swelling about an articulation and the animal 
may seem to be decidedly lame in the joint. As the di.sea.se 
advances, the paresis tends to increase until there is such com- 
plete paraly.sis that the animal is unable to ri.se when down. 
When the patient becomes unable to ri.se, a fatal termination 
usually occurs in the course of a few days to several weeks, 
largely hastened by the decubitis and the accompanying compli- 
cations. In other cases, after being recumbent for days or 
having had to be assisted in rising for weeks, the animal improves 
and eventually recovers. 

With, and even before, the advent of the paretic symptoms, 
there appears a very rapid emaciation, which is especially prom- 
inent in the posterior parts of the body. This emaciation is 
noticeable from the fact that it occurs in spite of a good appetite, 
and the allowance of abundant food with apparently good diges- 
tion. It seems that both the paralysis and emaciation are largely 
dependent upon changes taking place within the .spinal cord and 
that these symptoms naturally become most marked in those 
portions of the body posterior to the locality in the cord where 
the chief destruction has occurred. The .symptoms of the dis- 
turbances of the nervous system are not confined to any portion 
of the body, and there is frequently observed a paralysis of an 
ear or eyelid or of the lips or nose. In the stallion there is fre- 
quently a well marked change in the voice so that he can not 
whinny naturally. 

The sexual desire may remain unaffected throughout the dis- 
ea.se, and, in many stallions, the power to copulate is but little 
impaired, but in the earlier stages, during the tumefaction of the 
prepuce and penis, either from excessive erection or other cause, 
the stallion fails in many cases, to effect coition, and, late in the 
course of disease, the same inability may arise from loss of power 
in the penis or from extreme paralysis of the po.sterior parts. 
6 



82 Veterinary Obsteti'ics 

The effect of the disease upon the powers of reproduction is 
very profound. In the earlier stages, the stallion may be capa- 
ble of impregnating mares and, failing to infect them with the 
disease, they may give birth to healthy foals. As the disease 
progresses, while the stallion may still be capable of copulating, 
he is usually sterile. The mare which becomes infected does not, 
generally, conceive, or, if so, aborts so early that the conception 
is not observed. In the Illinois outbreak, it could not be deter- 
mined that a living foal had been born among loo diseased mares. 
Some writers claim that, occasionally, a diseased mare will pro- 
duce a living foal. 

Recovery raay,"and does, occur even after extreme emaciation, 
and when paralysis has been so complete that the animal could 
not rise without assistance. 

The duration of the disease may extend from three months to 
as many or more years, and recovery, either apparent or real, 
take place at any intervening time. 

Pathological Anatomy. In animals which have succumbed 
to the malady or been destroyed in its last stages, there is seen, 
quite uniformly, an evident degree of anaemia and emaciation. 
Distributed throughout nearly every tissue in the body, there is 
found a characteristic yellowish exudate of gelatinoid appearance, 
especially abundant in the subcutaneous and intermuscular con- 
nective tissue, in the mesentery, and all parts rich in connective 
tissue. Nearly every organ of the body partakes of the general 
yellowish tinge. The muscles, especiall}^ those of the thigh and 
croup, are pale and soft. 

The intestines are pale, and, in some cases, show signs of 
previous inflammation on their peritoneal surface. The mes- 
entery presents a pale saffron color, thickened by a gelatinous 
exudate. The mesenteric lymphatics are enlarged, pale yellow 
and friable. The spleen is pale, small, shriveled, tough and 
hard. The liver is soft and filled with dark blood. The kidneys 
are usually found somewhat enlarged, very pale and edematous. 

The genital organs fail to exhibit the extraordinary changes 
one would naturally expect to find. 

Autopsies made by us on several stallions, all diseased for one 
and one-half to over two years, showed the general conditions 
above indicated, while, in addition, in some cases the genitals 
showed marked changes and, in others, there were only very 



Dour 1716 83 

slight deviations from the normal. One very bad case, an im- 
ported French draft stallion, showed very great enlargement of 
the scrotum, which was hard and unyielding to the touch. The 
skin of the scrotum was enormously thickened and of a pale 
yellow color. The inguinal glands of the right side were the 
seat of an extensive abscess, opening at the upper part of the 
scrotum. A large abscess, occupying the usual position of the 
testicle, was filled with dark yellow, hard, chee.sy pus, which 
had pushed the gland from its place up into the inguinal canal. 
The testicle was small, atrophied, soft, flabby and pale yellow in 
color, with the serous covering firmly adherent at every part. 
The surface of the penis offered no evidence of disease. The 
urethra contained a small amoiint of a dirt}', purulent secretion ; 
the lining membrane was rough, graj'ish-yellow in color, with- 
out any appearance of ulcers. The seminal vesicles and enlarged 
portions of vasa deferentia contained thin, grayish, purulent 
accumulations. The left testicle was normal in size, with cover- 
ings firmly adherent at every part. No appearance of ulcers was 
found in the urethra or upon the penis of either of the several 
stallions examined. 

Investigators have observed inconstant changes in the nervous 
system, principally of injection of the coverings of the brain atid 
spinal cord, softening of the lower part of the cord and occa- 
sional extravasation of fluid into the ventricles of the brain. 
Thanhoffer describes extensive degeneration of the nuclei of the 
nerve cells in the spinal cord. The nasal mucous membrane 
usually shows catarrhal inflammation. 

Differential Diagnosis. Few contagious diseases of animals 
have been so confusedly described by veterinary writers. At 
first there was a very general confusion between Dourine and 
Genital Horse Pox, a condition which still continues in many 
descriptions of the malady. 

According to our observations, the most reliable local symp- 
toms for the diognosis of Dourine in the stallion consists of the 
doughy, elastic svi^elling of the prepuce, with varying degrees of 
penial paralysis, the penis hanging somewhat out of its sheath, 
usually retained within the prepuce. The urethral opening is 
usually inflamed and, from it, a slight discharge escapes, but 
there is nothing visible to the naked eye to mark this as differing 
from lesions of these parts due to other causes. 



84 Veterinary Obstetrics 

Later a depigmeutatiou of the penis and prepuce may occur, 
not in small circular spots, as in genital horse pox, but in large, 
irregular patches, which gradually spread from the periphery. 
In the mare, the most important local symptoms for purposes of 
diagnosis consist of the doughy, edematous swelling of the vulvar 
lips, the enlargement of the clitoris, the gaping of the vulva at 
its inferior commissure and the depigmentation of the clitoris, 
and its prepuce, and of the skin of the vulva, perineum and anus. 

Once it is decided that an equine venereal disease exists in a 
stud, the presence or absence of specific pustules or vesicles may 
serve largely to differentiate between the two maladies. 

Eruptions upon the external genitals ma}^, of course, occur in 
Dourine, but those writers who have mentioned them uniformly 
fail to describe them in a manner to enable one to differentiate 
those of Dourine from those of Genital Horse Pox, and, as a 
rule, it might well be suspected that such descriptions are based 
upon diagnostic error. In some cases, doubtless, erosions or 
ulcers have appeared as the result of irritation from ichorous dis- 
charges or from the accumulations of filth about the genitals, 
accompanied by low vitality in the cutaneous tissues ; but such 
eruptions are devoid of diagnostic value, their relation to the 
disease, so far as we know, being quite secondary. 

Specific eruptions of vesicles or pustules upon the genitals do not 
occur. When abundant and specific eruptio7is occur on the genitals 
of the horse, they indicate Genital Horse Pox, not Dourine. 

Dourine a7id Genital Horse Pox may readily coexist and thus 
add confusion in diagnosis. 

In the outbreak of Dourine in Illinois in 1886-7, we were in 
great doubt for a time as to our diagnosis in the case of a young 
stallion showing abundant pustules and vesicles on the penis, 
prepuce and sheath. The urethral meatus was inflamed, dark 
livid in color ; from it there was a thin grayish discharge ; the 
prepuce and sheath were swollen. Though the animal was 
within the zone of infection, no exposure could be traced. He 
transmitted Dourine to no mares, and recovered completely and 
permanently in a few days. Had it been possible to connect him 
in any way with the outbreak, it would have been difficult to 
attribute the eruptions to anything but Dourine, and, had he been 
actually affected with that maladj', we have no reason to believe 
that it would have prevented his becoming simultaneously in- 



Dourme 85 

fected with the far more common Genital Horse Pox. In the 
table on page 88 this animal is designated as No. XI. 

Some writers, in describing Dourine, accept the presence of de- 
pigmented areas about the vulva and anus as conclusive evidence 
of precedent ulceration, but depigmentation of the skin does not 
necessarily follow vesicular or pustular eruptions nor does its 
presence indicate that eruptions have occurred. We had excel- 
lent opportunit}- for observing, day by day and week by week, 
the depigmentation of the skin of the vulva and anus in Dourine 
and saw it begin and gradually spread, without the presence of 
any visible vesicles, papules or ulcers. It was a depigmentation 
without ulceration. 

Fleming, (Veterinary Sanitary Science and Police); Williams, 
(Principles and Practice of Veterinary Medicine) ; Law, (Veter- 
inary Medicine); Moore, (Pathology and Diagnosis of Infectious 
Diseases) and numerous other writers place emphasis upon the 
presence of specific eruptions in Dourine, but fail to describe their 
characters, and do not intimate that they have personally ob.served 
them. The only definite assertion by any author,so far as we have 
been able to find, that he has personally observed ulcers, papules 
or vesicles is that of Thanhoffer, who records instances of mares 
with eruptions about the perineum and inside the thighs and 
presents illustrations of cases ; but there is nothing in their char- 
acter of diagnostic vakie and it does not appear that the diag- 
nosis in these cases was verified. 

In the extensive Illinois outbreak, which was under our per- 
sonal charge, among more than 100 cases of the disease, not an 
instance of eruptions was observed nor could the most diligent 
inquiry among owners reveal any history of such in any animal. 
In this outbreak, the cases were observed daily for some months, 
and we were especially careful to search for these eruptions in 
recent and old cases because, relying upon the descriptions of va- 
rious writers, we expected to find them, and were disappointed 
and confused when we did not. 

European writers are generally inexact in reference to vesicu- 
lar and pustular eruptions and white spots upon the genital or- 
gans. One of the first writers to point out the distinction be- 
tween Dourine and the Genital Horse Pox and to assert that the 
former was without eruptions, was Rodloff. Baldrey, after an 



86 Veterinary Obstetrics 

extensive experience with the malady in India, fails to record 
the occurrence of vesicles and pustules. 

In the United States of America, there have occurred approxi- 
mately 300 cases of the disease, and so far as we can determine, 
no vesicles or pustules have been observed in any instance. 
Hutyra and Marek describe eruptions but, on page 464 of their 
Spezielle Pathologie und Therapie, they present the illustration, 
(Fig. 9), of a mare with depigmentation about the vulva, which 
they attribute to prior ulceration, but they do not illustrate any 
of these ulcers and the appearances in the picture are identical 
with the depigmented spots observed in America, which occurred 
without the prior existence of ve.sicles, pustules, ulcers or other 
visible destructive processes in the epithelial surface of the skin. 

In the Jahresbericht for 1902, de Does is quoted as having 
observed the depigmentation of the skin of the external genitals 
without precedent vesicles or pustules and regarded this loss of 
pigment as a marked symptom of the affection. 

It seems to us that the apparent differences in observation and 
view in reference to vesicles, pustules and loss of pigment is due 
to the constant confusion of the two wholly distinct venereal 
diseases and to accepting the erroneous conclusion that depig- 
mentation indicates prior pustular or vesicular eruptions. 

It should be further remarked in reference to the alleged oc- 
currence of eruptions that the character of the micro-organisms 
said to cause the disease is contradictory to the appearance of 
such lesions. Trypanosoma, in general, have little or no tend- 
ency to produce eruptions or suppuration, and it would seem 
unique to expect that, in this one disease, alone, of th-s great 
group, there should occur characteristic vesicles or pustules. 

The elliptical swellings or " talerfiecke " in the skin of the 
flanks, hips and other parts of the body have long held a high 
place in diagnostic value, but they do not always exist. 

In the Illinois outbreak, the enlarged and pigmentless clitoris 
constituted a noteworthy and highly diagnostic symptom in the 
mare, persisting for at least two }'ears after all other physical 
signs of the malady had disappeared. 

The paresis of Dourine is fairly characteristic ; accompanied 
by other lesions and symptoms it is pathognomic, while the 
peculiar jerky movements in the hind limbs during progression,. 



Doiirine 87 

and the knuckling over at the hind pasterns are rarely seen in 
other forms of disease. 

In addition, there is the clinical history of infection by coition, 
along with the malignancy of the malady. 

Finally, the finding of the tiypanosomum equiperditni in the 
blood of the animal serves to definitely establish the diagnosis. In 
many cases it seems to be very difficult to find the parasite in 
the. blood of the animal and, consequently, this proof of the 
character of the disease is not always readily produced. 

The Mortality from Douriue is very great and the loss amounts, 
upon the whole, to far more than the total value of the diseased 
animals. - When it has once become widely disseminated in a 
breeding district, it practically ruins the industry for a time be- 
cause its character is so insidious that it is exceedingly difficult 
to trace in it all its ramifications. The mortality among the 
affected animals reaches 60 to 80 %, which places it among the 
most fatal of infectious diseases. Those which recover do so 
very slowly and the time consumed before they are again fit for 
work is so great that it almost destroys their value. We have 
no data to show that an animal once affected can ever be bred 
again with safety, however completely' they may have apparently 
recovered or how long a period may have elapsed. 

The tabulated list on next page of affected stallions in the Illinois 
outbreak, copied from the author's report upon the disease, is of 
interest, as showing the transmissibility and mortality of the 
malady. 

Control and Eradication. There is no specific treatment 
known for the disease and, atpresent, the most that can be done 
is the securing of rest with favorable food and environment. 
Complications may be handled according to circumstances. Some 
investigators have obtained apparently favorable results from the 
administration of ansenic and other antiseptics but there is no 
definite evidence of specific action of these, though they are 
worthy of trial. In the Illinois outbreak, some animals recovered 
their general health after having been .so completely paralyzed 
that they constantly required assistance, for several weeks, in 
getting up. As a general rule, however, animals which become 
so weak and paralytic as to be unable to get up when down, 
soon succumb to the disease. 



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Dojirine * 89 

The plan of control adopted in the outbreak in Illinois was to 
Tiiake a rigid inspection of every breeding stallion within 
the infected zone and in the adjoining territory and to keep 
them under constant observation. In the case of each stall- 
ion which showed sj'mptoms of the disease or which had 
served a diseased mare or a mare which had later become diseased 
without other known exposure, his breeding record was examined 
in detail and each mare which had been bred to him was placed 
under quarantine and subjected to repeated observation. All 
animals which were found diseased were either destroA'ed and 
the owners compensated, or they were placed under a strict quar- 
antine for life, bj^ the terms of which they were allowed to be 
worked, but not to be bred, sold or exchanged. 

Under these conditions, almost all the affected mares were 
'killed and the few remaining ones were closely watched. The 
affected stallions were all destroyed. The mares which had been 
exposed to the disease, but had not become affected, were kept 
under quarantine for a year or more and subjected to rigid in- 
spection from time to time and were finally released when_ it 
seemed perfectly clear that they were not, and had not been, dis- 
ea.sed. The effect of these measures has been highly satisfac- 
tory and no recurrence of the disease has come to light during 
the twenty years which have elapsed since the outbreak. At 
that date the trypanosomum equiperdum was unknown and its 
presence or absence could not enter into the question of diag- 
nosis or control, physical symptoms alone being relied upon. 

Upon one occasion, during the early stages of control work, 
the owner of a stallion, who doubted the diseased condition of 
his animal, clandestine!}' permitted him to serve a mare, which 
became infected. The destruction of all affected stallions shortly 
thereafter put a stop to such accidents. 

It is of primary importance in all outbreaks of the disease to 
provide early for the entire cessation of breeding, or, we might 
more strictly say, of copulation or attempts at copulation between 
animals. In this respect, it is important that colts which are 
reaching the breeding age should be properly castrated or other- 
wise made secure. Stallions of breeding age, which have become 
affected, should be destroyed promptly, or placed under safe 
quarantine, since they constitute the greatest source of danger. 
Destruction of the affected animal is highly important, since in 



go * Veterinary Obstetrics 

many cases the owner is not fully convinced of the dangers from 
the disease and may carelessly violate any quarantine regulations 
imposed. 

There is the additional danger that employees of the owner, or 
others, ma}' violate the quarantine without his knowledge or con- 
sent, and thereby start the disease anew in a way which may be 
exceedingly confusing, or might work serious injustice to tlie- 
owners of healthy stallions. The feeling between competing" 
stallion owners in a community is not always of the best, and. 
they may seek to do a rival a very great injury. 

The castration of stallions does not insure inability to spread 
the disease. It is a well known fact that such castrated animals^ 
which have previously been used for breeding purposes, will con- 
tinue to copulate with mares which are in estrum and may, 
thereby, spread the disease. It has been recorded that geldings 
have contracted the maladj' and it is perfectly reasonable to- 
suppo.se that the accident occurred in this manner. The castra- 
tion of stallions is, consequently, not wholly safe and, if it is at 
all allowed, it should be accompanied by other safeguards which 
would prevent anj' accident. If such stallions are removed from 
breeding areas to city stables, where they are put to work, in case 
they have sufficiently recovered, they may cease to be dangerous 
so long as they are under reasonable supervision. 

The castration of mares has not been largely applied to the 
control of this disease, but may prove of important police value. 
If a mare has been exposed, but apparently not infected, there- 
may still linger a question of her safety, even though she has- 
not shown s5i'mptoms of the disease and, unless she is highly val- 
uable for breeding purposes, it may be better, in some cases, to- 
completely exclude her from breeding by causing her castration. 
Since this operation is comparatively safe upon the mare and is- 
readily carried out by an ordinary operator, it might well be 
largely emploj'ed in these outbreaks, and the animal then put to- 
work. 

Diseased mares should, in the present state of our knowledge,, 
be destroyed. They occasionally recover their general health 
and ability for work but, as already stated, we have no data to- 
show that such mares ever become entirely safe as breeding ani. 
mals and the danger to the hor.se breeding industry, as compared 
o the small value of the few apparently recovered mares, is so- 



Dourine 91 

overwhelming that it would seem poor policy to take the risk of 
a violation of quarantine regulations and the breeding of these 
animals by the owners. In the Illinois outbreak the opposite 
course was pursued and a small number of mares was allowed to 
live and used for work purposes under strict quarantine against 
breeding or disposal. Though the plan has not been followed hy 
any disaster, it was unsafe and necessitated prolonged vigilance. 
In the community where they were, however, each neighbor 
knew the history of each of these previoiislj^ diseased mares and 
would probably have reported any open violation of the quaran- 
tine very promptly. It is needless to say that careful watch 
should be kept over the breeding animals, especially the stallions, 
in the infected area for several years and prompt and rigid in- 
vestigations made upon the slightest su.spicion of a recurrence of 
the malady. 



2. GENITAL HORSE POX. COITAL EXANTHEM 
Eruptive Venereal Disease of the Horse. 

Genital Horse Pox is a highly contagious disease, which, 
under ordinary conditions, is transmitted by coition only and 
consists of a local infection of the genital, organs. It is far more 
readily transmitted than Dourine and has a shorter period of 
incubation. 

Symptoms After a period of two to five days subsequent 
to exposure, there appears in the mare an inflammation of the 
mucous membrane of the vulva and vagina, in which there arise 
small reddish papules, which soon become vesicular or pustular 
and rupture, leaving small erosions on the mucosa. From the 
vulva, there occurs a more or less copious, muco-purulent dis- 
charge, which soils the tail and neighboring parts. Urination is 
somewhat frequent and the contact of the urine with the denuded 
mucosa irritates that membrane and causes straining. 

At the same time, similar eruptions, appear upon the externa 
surface of the vulva, anus, perineum and surrounding parts. 
They behave somewhat similarly to the eruptions within the 
vulva and vagina. At first, a small papule arises in the skin, 
which soon becomes vesicular and this, in turn, pustular and 
assumes a yellowish-white color ; these mature quickly and soon 
rupture, to be followed by tough, yellow scabs, yi to }^ inch in 
diameter. After a few days, the crusts drop off and leave be- 
hind white scars very slightly depressed. These depigmented 
spots are circular in form and, in very severe cases, may coalesce 
somewhat. They tend, however, to remain distinct circular 
spots. The pigment returns after two or three weeks and no 
visible .scar remains. The vesicles appear in continuous crops 
over a period of one to three weeks, so that, at a given examina- 
tion, there may be eruptions in every stage. 

Accompanying these eruptions, there is swelling of the vulva, 
with some tenderness of the parts. Some writers have described 
also a prurigo or intense itching of the parts, causing the animal 
to violently rub the tail and vulva. Although we have personally 
observed a number of outbreaks, we have not seen this symp- 
tom in any case. Neither have we been able to find in the 
literature upon the subject any case where such a symptom has 
been recorded as a personal observation. 
92 



Genital Horse Pox 93 

111 the stallion, the sj'mptoms are virtually parallel. Erup- 
tions, of the same character as described upon the vulva and anus 
of the mare, appear upon the penis, prepuce and sheath of the 
horse. The opening of the urethra is swollen and congested 
and from it there is a muco-puruleut discharge. There is 
some swelling of the prepuce and possibly, to a less degree, of 
the penis. Ordinarily, there are no constitutional symptoms in 
either animal, there is no loss of appetite nor appreciable emacia- 
tion and the general condition of the animal remains undisturbed. 
In one case observed by us, there remained a year afterward an 
extensive chronic inflammation of the vagina and bladder, which 
virtually ruined the animal. In this case, the mucous membrane 
of the vulva and vagina was greatly thickened, corrugated, 
sensitive and bled easily upon touch. The bladder was highly 
inflamed, its mucosa greatly thickened, the urinary salts were 
deposited over its inner surface and its cavity was largely oblit- 
erated. The meatus urinarius was open and the urine dribbed 
away involuntarily, so that the tail and thighs were kept con- 
stantly befouled and presented a very repulsive appearance. 

The course of the disease is usually mild and brief. Most 
cases recover spontaneously in from two to three weeks and, 
under proper handling, recovery is hastened and rendered in- 
creasingly certain. 

The nature of the disease is not precisely known. A given 
outbreak is not usually traceable to any definite source of origin, 
but seems to become established in a community without having 
been imported by a diseased animal. Once it becomes estab- 
lished, almost every mare bred to an affected stallion contracts 
the disease with great uniformity. Presumably, it is just as 
transmissible to the stallion, but this is not so often observed, 
since the mares are not usually bred to different males during 
the .same season. Experiments have shown that the vesicles and 
pustules contain the element of contagion in a virulent form. 

Handling. The handling of the disease depends essentially 
upon disinfection and a temporary cessation of breeding, hsij 
disinfectant will answer the purpose, but it should not be highly 
irritant, since the parts involved are very sensitive. 

The handling of the stallion is most urgent so that he may 
resume service as promptly and safely as possible. From our 
experience we have come to prefer an antiseptic wash composed 



94 Veterinary Obstetrics 

of about I ounce of carbolic acid with 2 ounces of tannin and 6 
ounces of glycerine in i gallon of warm water. After washing 
the penis and prepuce thoroughly with soap and water, this solu- 
tion is applied freely twice daily and a quantity of it is injected 
up the urethra until it is supposed to reach nearly to the bladder. 

The extent of disease in the urethra has not been investigated. 
We only know that there is a urethral inflammation and dis- 
charge and that it is infective. The mere washing of the penis 
and prepuce cannot, therefore, bring about effective disinfection, 
but the urethra needs be included. The urethral injection is 
best made by means of a rubber bulb syringe or a gravity ir- 
rigating apparatus. The syringe or irrigator nozzle is insert- 
ed into the urethral opening and retained there while the an- 
tiseptic solution is forced upward as far as is deemed necessary. 
Should some of the fluid reach the bladder, it will not prove 
dangerous but it would be well not to overfill the urethral pass- 
age at first so that the infective discharges ma}' be largely ex- 
pelled before taking the risk of forcing them up into the bladder 
by an excess of the solution. The external ulcers resulting from 
the pustules may be touched lightly with stick nitrate of silver. 
The animal needs be kept as free as possible from sexual excite- 
ment, but should be allowed gentle exercise, along with a re- 
stricted, laxative diet. The stallion may be returned to the stud 
as soon as all evidences of disease have disappeared but, for a 
time, it might be advisable to continue the disinfection, especiall}' 
after each service. 

The handling of the mare should be along the same general 
line and should be persevered in until all symptoms have disap- 
peared. As a general rule, she will recover sufficiently during 
the interval between two estrual periods that she may again be 
bred at the first return of estrum since the contraction of the 
disease, should she not prove to be in foal. 

The differentiation of this affection from Dourine is highly 
important, but has already been discussed on page 83. 

There is little need for police control of this disease, since its 
symptoms are so prominent that laymen promptly note it and 
voluntarily withdraw the affected animal from breeding until re- 
covery has occurred. Should there at any time be a negligent 
tendency shown, the affected animals should be promptly quar- 
antined until all danger has passed. 



VENEREAL DISEASES OF CATTLE 

I. Vesicui-ar Exanthem. Aphthous Venereal Disease. 

The vesicular venereal disease of cattle is one of the most com- 
TOon and wide-spread of the entire group of venereal diseases of 
animals. It is a highly contagious malady, transmitted ordin- 
arily by copulation. 

The Symptoms are very similar to those of the Genital Horse 
Pox, already described. The first evidence of the disease in the 
■cow is an intense vaginitis, in which the mucous membrane of 
the vulva and vagina become greatlj' injected and swollen, soon 
followed by dark red points or petechise, which quickly develop 
into vesicles of very small size. These are at first transparent, 
"but may later become pustular, although they largely rupture 
■while yet in the vesicular stage. From these, very shallow ul- 
cers result and give rise to a muco-purulent discharge, which col- 
lects upon the tail and neighboring parts in the form of dry 
•crusts. 

In severe cases, the ulcers may acquire considerable depth, 
with irregular borders, and, in healing, may temporarily leave a 
stellate scar, though there is usually no prominent mark. In any 
case, they tend to develop completely in a short time. The cow 
•expresses pain and irritation by stepping to and fro with the 
hind feet and by movements of the tail. The act of urination is 
painful and causes straining because of the irritant effect of the 
urine upon the denuded mucous membrane. In some instances 
there seems to be an excessive estrum. 

When very severe, the cow may show some difficulty in moving, 
■owing to the tenderness of the inflamed organs. Manipulations 
•of the swollen vulva cause very evident pain and the inflamed 
mucous membrane bleeds very readily. The discharge from the 
-vulva is somewhat parallel to the degree of ulceration in the vulva 
.and vagina. If excessive, it may become irritant and cause ex- 
coriation of the parts with which it comes in contact. In very 
:severe cases, patches of the mucosa may become necrotic and 
slough away. 

The infection may or may not prevent impregnation and, when 
.aff^ecting a pregnant cow, it rarely causes abortion. The general 

95 



96 Veterinary Obstetrics - 

functions of tLe animal are not usually affected, the temperature 
and appetite remaining verj' nearl}- or quite normal. The affec- 
tion may lead to chronic catarrh of the vagina ; or it may result 
in adhesions between the walls of the vagina, more or less com- 
pletely closing that canal. 

In the bull, the penis and sheath are inflamed, swollen and 
tender. Eruptions of the same character as we have described 
in the cow appear also upon the penis, first as papules, whicli 
develop into vesicles, to be followed by ulcers. The urethra is 
similarly involved, as expressed by a muco-purulent discharge- 
This is further shown b5' the urine being frequently voided in 
small amounts, with appearances of pain. The swelling of the 
penis and its sheath tends to produce phimosis. 

Erection of the penis causes bleeding and this is especially 
evident immediately after copulation. Kanipmann records a 
case of extensive necrosis of the penis with a permanent de- 
formity. The duration of the disease is usually brief and gener- 
ally ends in spontaneous recovery in from one to four weeks. 
An outbreak in a stable may continue for a long time bj^ being 
transmitted first to one and then to another animal. One attack 
apparently confers little or no immunity and, when an animal 
has almost recovered, the disease may be renewed through- 
copulation. 

This affection should be differentiated from the granular ven- 
ereal disease of cattle. In the latter, vesicles and pustules are 
absent throughout and it runs a far more chronic and virulent 
course. We find no record of the latter affection in America, 
while the vesicular venereal disease is widely distributed. 

The prognosis is highly favorable and it is only rarely that 
material loss follows. 

The control of the disease must rest fundamentally upon the 
isolation of the affected animals. It is highly essential that the 
two sexes should be kept entirely apart. Even steers should not 
be allowed in an enclosure with cows, because they sometimes 
attempt copulation and may thereb} serve to transmit the 
disease. A diseased cow should not be permitted to stand in 
close proximity to healthy ones because the infection may be 
transmitted from one animal to the other through the medium of 
the tail, by soiled bedding or other means. Affected animals 
should on no account be bred until they have fully recovered. 



Granular Venereal Disease of Cattle 97 

Thorough disinfection of the stalls and of the diseased and soiled 
parts of the animals contributes materially to the control of an 
outbreak and the shortening of its duration. 

The treatment consists of the disinfection of the copulatory 
organs and those parts which become soiled from the discharges. 
The choice of a disinfectant is not of essential importance. 
Thorough mechanical cleansing by washing constitutes a highly 
important part of the handling. The disinfectants used should 
constantly be of such a character as to cause little irriation to 
the highly sensitive parts. One of the chief dangers to be an- 
ticipated is adhesions between contiguous mucous surfaces of the 
vagina or of the sheath of the penis. If the walls of the vagina 
or vulva adhere, because of the denudation of epithelium, breed- 
ing may be prevented, owing to the narrowing of the canal to 
such an extent that copulation cannot occur. In the bull, the 
penis may become adherent to the sheath so that it cannot be 
protruded, and coition thus be prevented. 

Such untoward results may be best anticipated, and recovery 
hastened and assured, by douching thoroughly with such mild 
disinfestants as J.4 % solution of carbohc acid, 1% alum solution 
or .1% permanganate of potash, repeated twice daily. The so- 
lution should be used at about the body temperature and intro- 
duced into the vagina or sheath by means of an irrigator, until 
the cavity is well distended, when it should be allowed to escape. 
Should the patient give indications, by straining, that the douche 
is painful, it should be reduced in strength until it is well borne. 

2. Granular Venereal Disease of Cattle. Infectious 
Vaginal Catarrh. Vaginitis Verrucosa 

Bibliography : Zschokke, Die Unfruchtbarkeit des Rindes ; Hutyra 
und Marek, Spezielle Pathologic und Therapie ; Hess, Schweitzer Archives 
f. Tierheilkunde, Band XLVIII, S. 351 ; Thorns, Monatshefte fur Praktische 
Tierheilkunde, B. XVII, S. 193. 

In many portions of continental Europe there exists a widely 
spread and highly contagious venereal disease of cattle, which 
causes very serious losses in dairies. So far as known, it is purely 
venereal, transmitted clinically, generally, if not always, by coi- 
tion, though capable of being transferred by other means. 
7 



98 Veterinary Obsteti'ics 

We have seen no record of its existence in America, but its 
wide dissemination in Europe, the chronic and somewhat insid- 
ious course of the disease, which may render it difficult of detec- 
tion at ports of entry, render it possible of importation. The 
want of any record of its presence, in this country, is not final 
proof of its non-existence, as it may be confused with the far 
less serious eruptive venereal disorder described in the preceding 
chapter. 

The maladj' has been recognized for twenty years and has been 
observed and described by numerous veterinary authors in Switz- 
erland, Germany, Italy, Denmark, Austria and other countries, 
from some of which America imports large numbers of dairy 
cattle. 

While not of importance, as related to the life of the affected 
animal, it becomes in other respects a verj' serious malady as 
affecting the dairying interests. It is highly contagious, involv- 
ing, in the infected zones, as high as 80 to 90% or even more of 
the total number of cows. Hutyra und Marek, citing Mueller, 
states that in East Prussia alone the disease involved 30,000 
dairy cows, while, in Switzerland and other countries, it has ac- 
quired a similarly extensive dissemination. 

It is a fertile cause of enzootic abortion. Thoms states that 
more than 50% of cows affected abort. In one outbreak, involv- 
ing 300 cows, about 70% aborted ; in another group of 296 cows 
there were 48 live calves. After the malady has prevailed in a 
dairy herd, a large proportion of cows become sterile, partly 
because of cystic ovaries, accompanied bj' nymphomania. In 
fact, this malady appears to be one of the common exciting 
causes of nymphomania with ovarian cysts. It may also lead to 
sterility in other ways. 

During the course of the malady and as a result of the direct 
irritation from the abortion and other interruptions, there is a 
great loss of milk. Thoms estimates the average losses upon 
each cow at 30 M. ($7.>o). According to those authors who 
have had extensive experience with the malady, it deserves to 
rank amongst the most serious of dairy plagues. 

Etiology. According to Ostertag and Hecker, the affection 
is due to a streptococcus consisting of 6-9 cocci, which are- held 
together by a delicate capsule. 



Gra7iular Ve7ie7-eal Disease of Cattle 99 

In artificial cultures, either alkaline or acid, and at the body 
or room temperature, the organism grows vigorously. It does 
not liquefy coagulated blood serum or gelatin nor coagulate 
milk. It forms neither gas nor indol. 

The disease is readily induced in healthly cows by vaginal in- 
oculation with pure cultures ar by discharges from the vagina 
of a diseased animal. 

Attempts at experimental transmission to other species of 
animals have resulted negatively. 

Naturally, the infection is transmitted almost wholly by copu- 
lation, an affected bull infecting almost all the cows with which he 
copulates. A bull which has recently served a diseased cow 
ma}^ transmit the malady to a sound one without becoming dis- 
eased himself. .Sometimes the transmission occurs through ordi- 
nary contact, without sexual intercourse. It may be accidentally 
transmitted to heifers or calves. 

The streptococci, having gained the vagina, penetrate the 
mucosa and are found between the epithelial cells and deeply 
within the papillse. The organisms have also been identified in 
nodules in the uterus, in the uterine mucosa and in the ovaries 
which have undergone cystic degeneration. 

In this way, apparently, they cause the very frequent sterility, 
while the wide area of distribution of the organisms and their 
depth within the tissues render disinfection and cure a complex 
and difficult problem. 

Symptoms. According to Ostertag, a vaginal catarrh be- 
comes established within 2-3 days after artificial inoculation, 
while, by natural or coital infection, one or two more days elapse 
before the catarrh becomes apparent. Raebiger observed va- 
ginitis and catarrh in 24 hours. 

The first symptoms of the malady to be noted consist of swell- 
ing of the labise of the vulva and a diffused or streaked reddening 
and swelling of the vulvo- vaginal mucosa, with tenderness of 'the 
parts. The inflamed area is covered somewhat by a muco- 
purulent discharge. 

A day or two later there develop in the vestibule of the vulva 
along the floor and sides about the clitoris numerous small nodules 
jig- to |- inch in diameter, which are at first dark red, later be- 
coming lighter in color. These nodules are smooth and of very 



lOO Veterinary Obstetrics 

firm consistence and are somewhat regularly arranged in parallel 
rows, as shown in Fig. lo. 




KiG. lo. Infectious Granular Vagiitis. 

Mucosa of the vestibule after three months duration of the dis- 
ease. (Hutyra and Marek, after Ostertag.) 



Granular l^enereal Disease of Cattle . loi 

The nodules consist essentially of hypertrophied papillary 
bodies. If the vulva is held open and reflected light thrown into 
the cavit)', the nodules can be readily distinguished ; they are 
also readily recognizable by the sense of touch. 

The mucous membrane is swollen, red and sensitive, bleeds 
easily upon manipulation and is covered by an inodorous mucous 
or muco-purulent secretion, which, flowing from the vulva, soils 
the labise, tail and adjacent parts, where it dries in brown crusts 
or, if in larger amounts, may flow from the vulva in long, ropy 
masses. The denudation of the mucosa renders it quite sensitive 
to the passage of urine over it, and the pain and irritation in the 
part tends to cause urination with abnormal frequencj^. 

When the disease extends into the cavity of the gravid uterus, 
which appears to be almost the rule, abortion occurs, while, in the 
non-pregnant cow, n3'mphomania and sterilitj' are common 
results. 

The acute stage of the malady continues for 20 to 30 days, when 
the swelling and tenderness abate and the nodules lose their red 
color to become somewhat yellowish or grayish, perhaps some- 
what transparent ; but the discharge and the granules persist for 
90 to 100 days, or more. 

Vesicles, pustules or ulcers do not ordinarily occur, though ul- 
cers and phlegmon have been very rarel}' recorded. Bulls show 
a comparatively high resistance to the infection, and, though 
they constitute the chief vehicle for the contagion, apparently 
suffer slightly, if at all, in most cases. 

When affected, they show analogous S3'mptoms to those observed 
in the cow. The penis is studded over with nodules, like those 
of the vagina, which are easily seen when the organ is extruded. 
Erection, copulation or manipulation of the penis causes bleeding. 
There is a muco-purulent discharge from the sheath of the penis, 
which adheres to and soils the parts. 

Treatment. The handling of the malady consists essentially 
of local disinfection, and, as in other localized infections, there 
should be a thoroughness in application conformable to the in- 
tricacy. We have stated above, that the cocci are found deeply 
insinuated between the epithelial cells, and yet deeper within 
the papillary bodies, that they may extend to the mucosa of 
the OS uteri, to the oviducts and even to the ovaries. Safe recov- 
ery includes the successful destruction of the organisms in all 



I02 • Veterinary Obstetrics 

these organs and tissues. The disinfectants used must not be too 
irritant to the highly sensitive mucosa of the genital passages, 
since they induce straining, inflammation, adhesions and other dis- 
agreeable consequences. Disinfecting douches, ointments, pow- 
ders and tampons have been commended, all having a common 
aim. Among douches there have been suggested 2 to 2j^% solu- 
tionsof lysol, creolin and similar drugs; .5% silver nitrate, . i ^fc 
potassium permanganate, 5% ichthyol, etc. Likewise, with pow- 
ders, a wide variation is available, such as zinc sulphate, alum, 
tannin and others, reduced by mixing with starch or other inert 
powder. In this group, we should also mention iodoform, be- 
cause of its local anaesthetic action, its weight, which would 
cause it to drop into the depressions between the elevations of 
the mucosa, and its comparative insolubility, causing it to re- 
main in position for 24 and more hours, presumably to be slow- 
ly converted into iodine. It has one very serious objection in the 
dairy, its odor, which is at all times liable to taint the milk. If 
it is to be used, great care should be taken in its application, 
some person other than the milker appl3'ing it, since his hands 
inevitably become somewhat saturated with the drug. 

It may be best introduced by means of a gelatine capsule, to 
be later broken and the powder liberated. Other drugs, like lysol 
and creolin, require cautious handling in the dair)', to avoid the 
contamination of the milk. In the use of tampons, the vulvo-vagi- 
nal cavit}' ma}' be packed with gauze or cotton saturated with a 
disinfectant. Usually animals resist the presence of a tampon in 
the vulva or vagina and tend to expel it. 

Some experienced practitioners praise anti.septic ointments very 
highly. They may vary greatly in composition and consist of 
well nigh any disinfectant, incorporated with a heavy fat, like 
cocoa butter, wax or tallow. The latter is very cheap and may 
have added to it a little wax in order to give it the proper firm- 
ness. Along with the desired antiseptics, the mixture may be 
placed over a fire and brought to the melting point, when all in- 
gredients are mixed, and, while still soft, may be molded into 
suppositories, say in form of a candle, about one-half to one inch 
thick by five to eight inches in length. Such suppositories are 
very readily introduced through the vulva, and, unless containing 
highly irritant antiseptics, are well borne by the patient. 



Granular I'enereal Disease of Cattle 103 

Affected bulls are to be handled along the same general lines 
as described for cows. 

The prophylaxis and control of the malady is highly impor- 
tant and, in a general way, demands the enforcement of the usual 
regulations for the control of contagious diseases. Of the first 
importance is sexual isolation ; coition must be prohibited until 
the disease has wholly disappeared in the two animals to be 
mated, not alone because a diseased animal will quite surely 
transmit it by copulating with a sound one, but because coition 
tends constantly to arouse the disease to new and increased ac- 
tivity. In addition there needs be general isolation of the dis- 
eased from the healthy, with thorough and efficient disinfection 
of the, stalls and all portions of the stable. 

In a suspected herd, the penis and sheath of the bull should 
be thoroughly disinfected by means of a reliable douche, both 
immediately before and after copulation. This is easily accom- 
plished by placing a barrel or other container, filled with a relia- 
ble antiseptic, in a convenient elevated place, from which the 
fluid may flow by gravity, and attaching to it, by means of a 
faucet, a piece of rubber tubing 10 to 15 feet long, the free end 
of which may be inserted into the opening of the sheath and the 
cavity thoroughly douched. In regions where the malady exists 
or is suspected, efficient quarantine should be enforced against 
the entrance into the herd of diseased or suspected animals. 



VENEREAL DISEASE OF THE DOG. VENEREAL 
GRANULAMOTA. LYMPHO-SARCOMA 

In the dog, there is observed a specific venereal disease con- 
sisting of grauulomata upon the genital mucosa. The disease is 
somewhat wide-spread in Great Britain and continental Europe. 
It is observed in various portions of the United States, largelj' in 
dogs recently imported. It seems most common in large cities. 
In the male it affects chiefly the penis and prepuce and some- 
times invades the adjacent tissues. Metastatic disease of the 
inguinal glands may follow. In the female it involves primarily 
and chiefl)' the vulva. It is naturally transmitted by copulation 
only, but may be otherwise spread by artificial or accidental 
inoculation. 




Fig. II. Infectious Venereal Granuloma^of Dog. (C.A.White.) 

Symptoms. The first symptom usuallj' noted is a bloody dis- 
charge from the prepuce or vulva, accompanied by tumefaction of 
the parts. If the penis is exposed at this time, there are .seen'pink 
or grayish red vegetations, largely upon the glans or at the ba,se 
of the penis where the penial mucosa passes over to the sheath or, 
104 



Venereal Disease of the Dog 



105 



at times, upon other parts of the mucosa. These tumors are soft and 
friable and bleed freel}' upon being touched. They may be sessile 
or somewhat pedunculated, resembling warts. The affection is of 
a chronic character and seems to have no definite limitation, the 
vegetations continuing to increase in size month by month and 




T'iG. 1 2 A. Infectious Venereal Granui,oma of Bitch. (C. A. "White. ) 

finally become firm, lobulated masses, so intensely injected that 
they assume a dark color. 

In the bitch, the symptoms are very similar. There is first a 
bloody discharge from the vulva. Examination of the vulva and 
vagina reveals vegetations of the same appearance as already 
noted in the male. These appear chiefly along the floor of the 
vulva and, when very large, may protrude externally. The dis- 
charge from the vulva is usually fetid. According to French, 



io6 



Veterinary Obstetrics 



males sometimes show an aversion to mating with affected 
females. 

Beebe and Ewing (Jour. Med. Research, Sept., 1906, do. Vet. 
Jour., July, 1907) record the presence in these tumors of spi- 
rochsete in one out of a series of cases, but failed to connect their 
presence with the cause of the malady. 




Fig. 12B. Infectious Venereai, Gr.4.nui<oma of Bitch. (C. A. White.) 



Later, Mettam (Veterinary Journal, February, 1907) records 
the discovery of an organism in this disease belonging to the 
group of spirochsete, which he believes to be the specific cause. 

Histologically, the tumors consist of large round or polyg- 
onal cells, which multiply rapidly and push the contiguous 
tissues aside without their becoming involved in inflammatory 
or other disease changes. 

The disease has been repeatedly transmitted experimentally by 
inoculations in the genital mucosa and other tissues. 



Venereal Disease of the Dog 107 

In clinical and experimental cases the neoplasms may not re- 
main coniined to the genital organs, but may involve the skin, 
the lymphatic glands of various portions of the body, the liver, 
spleen and other glands, 

The treatment is not highlj' satisfactory unless undertaken 
early. It consists chief!}' in excising the vegetations, along with 
a small area of the healthy mucosa, after which the edges of the 
wound should be drawn together with catgut. 

In the male, it may be necessary to divide the prepuce and, in 
the female, the perineum, in order to reach all the diseased parts. 
Afterwards, these wounds should be sutured. It is well to place 
the animal under general anaesthesia for the operation, which 
should be repeated within one to three weeks if necessary, and 
in some cases, cautery may be resorted to. In inveterate cases 
it may be necessary to amputate the penis and prepuce. Hobday 
states that the disease may be favorably affected by castration. 



VENEREAL DISEASE OF SHEEP. 

Flook (Jour. Comp. Path, and Ther., Vol. XVI, p. 374) records 
an outbreak of a venereal disease among sheep which came under 
his observation. He relates that, in a herd of fifty- two yearling 
ewes and two ram lambs, which had been recently purchased, it 
was noted that one of the rams had a discharge from the sheath, 
while the other had extensive eruptions about the mouth and 
nose. Nothing was seen amiss with the ewes. Soon after pur- 
chase, the two rams were taken from the band with which they 
had been purchased and placed with a small flock of old ewes. 
After one week F. found nine of the old ewes showing great 
swelling of the vulvas, with raw, bleeding sores upon the mucous 
and cutaneous surfaces of the lips of the vulva. An examination 
of the rams revealed ulcerating sores in the sheath of one and 
eruptions upon the upper lip of the other. The general health 
of the animals was not apparently disturbed. 

The rams had been marked with color upon the breast between 
the forelegs so that each ewe which was served could be identified 
and, by this means, it seemed to be determined that two of the 
latter had contracted the disease without coition. F. suggests 
that, in these two, the disease may have been transmitted by the 
ram which had the eruptions on his upper lip, through smelling' 
of the vulvse of these two animals, or that it might have been 
caused by flies bearing the disease from one animal to another, 
since the affection appeared during the month of August. The 
affected ewes were isolated and the sores dressed with antiseptics. 
Gradually they all recovered. 

On the following page of the same journal, Sir John McFad- 
yean contributes observations made by himself upon an out. 
break which he considers identical with that described by F. , 
which he also observed. He saw twelve ewes affected in one 
flock, showing intense inflammation, swelling and tenderness of 
the vulva. The vulvar mucosa was inflamed and some ulcers 
were present, both on the mucous membrane and the skin. 
There was a slight purulent discharge from the vulva. As these 
ewes had been served by a hired ram, which had been returned 
to his owner six days previously, McFadyean failed to see the 
108 



Venereal Disease of Sheep 109 

animal. McFad3'ean attempted to produce the disease experiment- 
ally by collecting the discharges upon pledgets of cotton, one of 
which was introduced into the vulva of a ewe, another into that 
of a cow and a third into the sheath of a wether. 

Though two of these experiments proved negative, in the 
wether, a swelling of the sheath was apparent two days after the 
inoculation. This was still further increased on the 4th day and 
accompanied by a slight discharge. The swelling, at this time, 
was sufficient to make the exposure of the penis impossible. 
The symptoms continued over a period of about two weeks. On 
the third day there appeared on the skin near the opening of the 
sheath a small sore, which was covered with a brownish scab. 
This sore continued to spread around the opening of the sheath. 
On the fifteenth day after inoculation, two small abscesses had 
formed on the prepuce near the primary sore ; these ruptured 
the next day, leaving shallow ulcers. At this time, a third small 
abscess had formed. All the ulcers were covered later with 
brownish crusts, after which they began to heal. Attempts to 
artificially transfer the disease from this animal to another 
wether and ewe failed. McFadyean did not succeed in isolating 
any organism which he believed to be the cause of the disease. 
While both outbreaks here mentioned have been comparatively 
mild in their course, McFadyean remarks that it is worthy of 
careful observation and that newly purchased rams might well 
be examined with a reference to this affection before being used 
for breeding. 

G. H. Williams (Vet. Jour. Vol. XVII, p. 64) records two more 
outbreaks of this disease. In his first, in a flock of eight eweS 
and one ram, two ewes and the ram were affected. There was 
balanitis and ulceration of the penis. He used chinosol and zinc 
sulphate, in solution, to the parts and they recovered in about 
two weeks. In his second outbreak, three rams and forty ewes, 
in a flock of fifty, showed the same symptoms as described by 
Flook and M'Fadyean. In one ewe, eruptions occurred upon 
the nostril. In some of his cases, the vulva was greatly swol- 
len and distorted and, in others, there were extensive granu- 
lations of a dark color, which protruded out through the vulva. 
The graulations and ulcers were penciled with silver nitrate 
and the entire parts were washed with a solution of zinc sulphate 
and chinosol. 



no Veterinary Obstetrics 

In another flock of ewes, which had not associated with this 
one, except that one of the rams had been with them, it was 
found that some twelve of them had eruptions about the lips and 
and noses, but no genital affection was present. A second ram, in 
this lot, escaped the disease, so far as seen. In the larger flock 
of ewes, the rams were isolated and the affected ewes removed 
immediately from the herd. Daily inspection was made of the 
apparently well ewes, and any which developed the symptoms of 
the disease were promptly separated. A few weeks later breed- 
ing was resumed without recurrence of the disease, and, in due 
time, the ewes dropped healthy lambs. 

INFECTIOUS VENEREAL DISEASE OF RABBITS 

Friedberger and Frohner (Spezielle Pathologic und Therapie, 
1904, page 501), describe an infectious disease of rabbits which 
was transmitted chiefly, or wholly, through copulation. The af- 
fection appeared in an extensive breeding establishment of rab- 
bits, and consisted of an inflammatory disease of the organs of 
copulation. It VA'as transmitted by coition from buck to doe, and 
vice versa. There were extensive swellings of the genital or- 
gans in both sexes, accompanied by a muco-purulent discharge. 
The disease was finally eradicated by injections of a solution of 
sulphate of copper, i to 2 % , extending over a period of some 
weeks. 

VENEREAL DISEASES OF SWINE AND GOATS 

Hutyra und Marek mention the occurrence of venereal disease 
in swine, and Friedberger und Froehner state that it occurs rarely 
in swine and goats, but neither of these authors record any de- 
finite observations upon either malad^^ 



OTHER INFECTIONS OF THE GENITAL ORGANS 
Bursattee of the Penis and Prepuce. 

Genital bursattee presents characters suggesting, to the inex- 
perienced, a venereal disorder, and constitutes an annoying dis- 
ease in breeding stallions. It is not infrequent in those countries 
where this malady prevails in other portions of the body. In our 
experience, bursattee shows a distinct tendency to attack the 
penis and prepuce of breeding stallions, especially of heavy draft 
animals. The infection is, persumably, not coital but is trans- 
mitted by other means : accidental wounds, flies or other carriers. 

The usual symptoms of penial bursattee, when first observed 
by the groom or owner, is the presence about the urethral open- 
ing of an angry-looking fungoid growth, which bleeds upon the 
slightest touch and is generallj' observed to bleed immediately 
after coition ; or, during erection, blood will drip from the tumor. 
Another fungoid mass of similar appearance exists at the prepu- 
tial ring upon the inferior or urethral side near the middle of 
the organ when erected ; that point where the urethral opening 
rests when the penis is fully withdrawn within its sheath. When 
the penis is at rest, therefore, the growths about the urethral 
opening and on the preputial ring are in immediate contact ; the 
preputial growth has emanated from that about the urethral 
opening, as a consequence of contact. 

The bursattic growth may begin at other points or may ex- 
tend from the seat of infection to neighboring parts. In one 
instance, we observed the disease beginning upon the scrotum. 

If the new growth is closely inspected, it is usually possible to 
recognize readily with the naked eye the small yellow concre- 
tions or ' ' kunkurs ' ' characteristic of the malady. In some 
cases, the penial bursattee is accompanied by infections upon the 
feet or other parts. 

So far as we have observed, the disease is not transmitted to 
mares through copulation, though, clinically, it behaves as an 
infectious malady and it seems not impossible that danger of 
transmission to the mare through the vagina may exist. 

The micro-biology of the disease has not been fully deter- 
mined, some attributing it to nematode worms, others to the 
presence of a fungus. 



112 Veterinary Obstetrics 

Ivike bursattee of other parts, it is active in temperate coun- 
tries onl}' during the hot season and undergoes apparent spon- 
taneous recovery upon the advent of winter, to remain dormant 
until the return of warm weather. It thus incidental!)' assumes- 
its greatest activity during the breeding season and interferes 
seriously with stud duties. Aside from the remote possibility of 
transmission, it is very noticeable, and owners of mares naturally 
do not care to breed them to a stallion so palpably diseased. 
Furthermore, the sexual excitement incidental to breeding" 
greatly influences the disease and adds to its virulence, each 
erection of the penis, with the consequent congestion of the 
organ, causing the bursattee growth to bleed. 

The handling of the disease consists of the destruction or re- 
moval of all infected tissues and the avoidance of venereal excite- 
ment. If undertaken early, the disease is usually confined to- 
the urethral tube, filling it and protruding beyond the navicular 
fossa, and may extend up higher in the urethra. Whatever the 
extent, the diseased tissues are to be excised or curetted away 
and the parts well cauterized with silver nitrate or the thermo- 
cautery, after which the wound may be dressed with iodoform, 
which apparently exerts a very beneficial influence upon the 
course of the disease, should any remain. 

Before operating, it is well to apply local anaesthesia, though 
the sensitiveness of the part is not marked, as is usuallj' the case 
with bursattic growths. Successful handling demands the with- 
drawal of the animal from the stud and the prevention of sex- 
ual excitement. If necessary, erection of the penis should be- 
prevented by the application of a stallion guard. 

At the preputial ring, at that point where the opening of the- 
urethral tube rests when the penis is completely withdrawn, the- 
secondary bursattic growth is more amenable to managements 
Here the operator can freely excise the diseased tissue without: 
danger of unpleasant deformity. 

After excision or destruction of the disea.sed tissues, the parts 
should be kept scrupulously clean, to which end it is advisable to- 
wash the penis, prepuce and sheath twice daily, with soap and 
water, to which Y-z @ i% of carbolic acid may be advantageously 
added. After cleansing, the parts may be dressed with powdered, 
iodoform, or iodoform ointment. Before applying the iodoform,, 
any suspicious areas may be cauterized with stick nitrate of silver. 



Actinomycosis of Genital Organs 113 

Actinomycosis of the Genital Organs. 

In cattle, actinom5'cosis of the external or internal genital or- 
gans may occur in such a manner as to suggest venereal infec- 
tion or, by their presence, may interfere with coition or fecund- 
tion. 

In a Galloway bull, we observed an actinomycotic tumor weigh- 
ing about two pounds, which was located in the elongated naked 
prepuce and prevented the protrusion of the penis. There were 
also similar actinomycotic new-growths present in the inguinal 
lymphatic glands. In another case, to which we shall again have 
occasion to refer when considering sterility, actinomycotic ab- 
cesses occurred in the broad ligament of the uterus, without ac- 
tinomycotic lesions in other organs. This would suggest that 
the infection had been introduced into the vagina during coition. 



MENSTRUATION 

In all domestic mammals, there occurs in those females of 
breeding age, at the time of estrum, an excitation of the genital 
tract with increased activity of the mucous glands, especially of 
the vagina and vulva, which leads to a more or less pronounced 
discharge of mucus. 

In addition to this increased production of mucus, there occurs 
in some animals, during or immediately subsequent to estrum, 
an evident discharge of blood from the vulva, which, mixed with 
mucus and epithelial debris, is known as the menstrual fluid ; 
the process, as menstruation. The phenomenon is not so con- 
spicuous in any of our domestic animals as is ordinarily observed 
in woman, and, for the most part, usually passes unobserved, 
if present. It is quite commonly noted in the cow and bitch. It 
has been recorded in the mare by Fleming (Veterinary Obstet- 
rics) and Kaiser (Magazine, 1859). Many regard estrum and 
menstruation as synonymous. While they are intimately re- 
lated, we prefer to regard them as two separate phenomena, as 
observed among domestic animals. 

While estrum is common to all mammalian animals of breed- 
ing age at the breeding period, menstruation, or a muco-sanguin- 
ous vaginal discharge, is not observable in most species at all, 
and, in the cow, where it is most conspicuous, it ordinarily does 
not occur during, but subsequent to, her very brief estrual period. 
In the bitch, the relation is not so well determined, the estrual 
and menstrual phenomena being of greater duration and over- 
, lapping or occurring simultaneously. In the cow, there is very 
frequently noted at or near the close of the period of sexual de- 
sire a well marked discharge of blood from the vulva. The 
amount varies greatly, usually being limited to a sufficient quan- 
tity to plainly stain the tail and surrrounding parts so that they 
are distinctly bloody, but sometimes there is a large amount of 
blood of a bright red color, mixed with mucus, seen hanging from 
the inferior vulvar commissure. In a few cases we have observed 
quite a voluminous discharge of blood, amounting at times to 
several ounces and accompanied by some constitutional disturb- 
ance, consisting chiefly of decreased appetite and a loss of milk. 
This sanious discharge in the cow continues usually for only a 
114 



Fertilization 1 1 5 

very brief period of five to twelve hours. During this interval 
the cow maj' copulate but estrum is not well marked. In the 
bitch the discharge appears during estrum and continues for some 
days without usually being very profuse. 

Fertilization. 

Fertilization is the successful union of the male generative cell 
or spermatozoon with the female egg or ovum, by which the re- 
sulting cell acquires the power of segmentation and is enabled to 
develop into an embryo. 

According to Marshall and other enibryologists, fertilization 
in the rabbit occurs in from eight to twelve hours after copula- 
tion. This interval is not due to the time required for the mi- 
gration of the spermatozoa from the posterior portion of the 
genital canal to and through the oviduct, but to the fact that the 
ova are not discharged from the ovary until eight to twelve hours 
after copulation. In the rabbit, the spermatozoa are found to 
travel the length of the uterus and oviducts in from fifteen 
minutes to two hours and, in the ordinary course of events, are 
already in the pavillion of the tube, awaiting the discharge of 
the ova. The doe rabbit copulates with the buck immediately 
after giving birth to young, the interval between estrual periods 
being the same as the duration of pregnancy. 

We are not aware that any exact observations have been made 
in our larger domestic animals demonstrating the length of time 
elapsing between copulation and fertilization. In spaj'ing cows, 
we have regularly observed that one which is in estrum has ripe 
ovisacs, which generally rupture the moment the ovarj' is 
grasped. If the cow has been in estrum on the previous day, 
we have found the Graafian follicle freshly ruptured. This 
would indicate to us that in the cow, as in the rabbit, ovulation 
occurs late in the estrual period or just at its close so that, under 
normal conditions, copulation would precede ovulation and hence 
that, in the cow, as in the rabbit, ovulation and fertilization 
occur some hours after the act of coition. In the rabbit, fertili- 
zation usually takes place immediately after the eggs enter the 
oviduct, which is probably the general rule in mammalia. 

If eggs be taken from the upper portion of the oviduct, sperm- 
atozoa will usually be found imbedded in the zona radiata or 



ii6 Veterinary Obstetrics 

lying in the space between the vitelline membrane and the egg. 
The exact process of fertilization has not been fully determined 
in our higher animals. It is generally held that a single .sperma- 
tozoon fuses with the female pronucleus. 

The Relation between Estrum, Ovulation, Fertilization 
and Menstruation. 

The relationship existing between the phenomena of estrum, 
ovulation, fertilization and menstruation has not been clearly 
determined. Owing to the very brief duration of estrum in the 
cow, she offers a specially favorable opportunity for study. As 
already related in our personal experience in the spaying of 
cows, it has been found that estrum is the first of these phenom- 
ena to present itself and that, if the ovaries be examined dur- 
ing the estrual period, it is found that there. is an enlarged, 
mature Graafian follicle ready to rupture and that the walls give 
way under ordinary manipulation allowing the follicular con- 
tents to escape. 

If the ovaries be examined during menstruation, it is found 
that the ovisac has ruptured and its contents have escaped. It 
seems, therefore, that, in the cow at least, the chronologic order 
of these phenomena is estrum, ovulation and menstruation, pro- 
vided that this cycle is not interrupted by copulation and ferti- 
lization, when the order would be estrum, copulation, ovulation, 
fertilization. If successful copulation ensues early in estrum, 
it is the general observation that menstruation does not occur. 
Thus, its advent would seem to indicate the death and expulsion 
of the ovum along with some of the epithelium of the uterus, 
accompanied by hemorrhage in a manner to correspond in a way 
to the lochial discharge of parturition. 

It would appear that, in our higher animals, the phenomenon 
of menstruation is analogous iu a way to parturition itself. In 
animals having a duration of pregnancy greater than the in- 
terval between two estrual periods, estrum becomes interrupted 
during gestation, except in rare pathologic cases. The follow- 
ing table by Simons (Graduation Thesis, Library of New 
York State Veterinary College, 1903) shows some interesting 
observations in reference to the relationship existing between 
this group of phenomenona and brings out especially the influ- 
ence of impregnation upon the occurrence of estrum. In those 



Relation between Estruni, Ovulatioti, Fertilization, etc. 117 

animals where menstruation occurred, it is indicated by + , while, 
in those in which no sanious discharge could be recognized, the 
fact is indicated by — . 



REI<ATIONSHIP BETWEEN ESTRUM, OVULATION, FERTIL- 
IZATION AND Menstruation. 









a 






^ 






3 m 










"3 




§'E 


ri 


"o 






U-. 1) 


_o 







gig 


T3 


OM 

Is 


13 

3 




i 
% 


1 


p 

Q 






I 


8.00 a. m. 
6-14 


6.00 P. M. 
6-14 


10 


- 





II 


5.30 a. m. 
6-16 


5.00 P. M. 
6-16 


12 


" 





III 


3.00 p. M. 
6-16 


5.30 A. M. 
6-17 


15 


— 





IV 


8.00 A. M. 
6-17 


4.00 P. M. 
6-18 


32 


-1- 


July 8 


V 


6.00 A. M. 
6-17 


6.00 P. M. 
6-17 


12 


— 





VI 


12.00 A. M. 
6-20 


9.00 A M. 
6-21 


21 


+ 


July 12 


VII 


5.00 P. M. 
-6-20 


5.00 A. M. 

6-ii 


12 


— 





VIII 


3.00 P. M. 
6-23 


9.00 P. M. 
6-25 


6 


— 





IX 


11.00 A. M. 
6-25 


9.00 P. M. 
6-25 


II 







X 


5.00 P. M. 
6-27 


9.00 P. M. 
6-28 


4 


-h 


August 8 


XI 


4.00 P M. 
6-29 


S.OO A. M. 
6-30 


16 


— 





XII 


6.30 P. M. 

6 29 


5.30 A.M. 
6-30 


II 


- 





XIII 


5.00 A. M. 

7-2 


6.00 A. M. 
7-2 


2 







XIV 


12.00 A. M. 

7-5 


7.00 P. M. 

7-5 


7 


~ 





XV 


5.30 A. M. 

7-8 


6.00 p. M. 

7-8 


13 


~ 





XVI 


4.00 P. M. 
7-12 


9.00 p. M. 
7-12 


5 







XVII 


5.30 P. M. 

7-24 


7.00 A. M. 
7-25 


13 


— 





XVIII 


5.00 A. M. 
7-13 




34 


-h 


7-25 


XIX 


8.00 A. M. 

7-6 




40 


-1- 


7-27 


XX 


10.00 A. M. 




23 


+ 


7-31 




7-12 







ii8 Veterinary Obstetrics 

"In cases IV and V, two heifers subject to the same condi- 
tions, the second was bred early during estrum, while the other 
was allowed to go until menstruation was well established, then 
served and, as a result, was not fecundated. Nos. VI and X 
were handled in the same way as No. IV and they also failed of 
fecundation. These cases were taken from a number for the 
reason that they were the most typical. They show that after 
service, which, in the successful cases, occurred before menstrua- 
tion, the latter did not take place. Instead, the animal quickly 
returned to its normal condition and continued as before estrum 
was present. Cases Nos. IV, VI and X, at the end of 21 days or 
thereabouts, were again in estrum with the same regularity 
as though they had not been bred, when they again were served, 
but this time before menstruation began, and became fecundated. 

Some observations were also made upon the length of time be- 
tween successive periods of estrum. This occurs quite regularly 
in cycles of from 20 to 25 days, usually about 21 days being 
given, though this is, of course, subject to variation." 

A careful study of this table would indicate that, in the breed- 
ing of cows, it should be the constant aim to cause copulation to 
occur somewhat early during the period of estrum. Whether it 
is possible for it to occur too early after the establishment of 
estrum is uot verj' clearly determined, but it would seem that, 
ordinaril}', it should take place in the cow within twelve hours 
from the beginning of the period. In the twenty cases observed 
by Simons, the longest duration of estrum prior to successful 
copulation was sixteen hours in case XI. 

In abnormal or pathologic conditions of the genital organs, 
these relations become somewhat varied and unreliable. In a 
typical instance related by Simons of a nymphomaniac cow 
which was in estrum each eight to twelve days, repeated service 
was ineffective. The removal of the ovaries showed them to be 
about double the normal size and cystic. This cystic condition 
prevented alike ovulation and impregnation. Other conditions 
serve to interrupt the normal order and lead to variations in the 
cycle of estrum and menstruation. 

These observations, although brief and fragmentary, suggest 
that successful impregnation prevents the occurrence of menstru- 
ation and that, consequently, its presence, in a cow after breed- 
ing, may be accepted as important evidence that fertilization has 
not taken place. 



STERILITY 

Standing at the threshold of success in livestock breeding, is 
the question of the capability of the animal, set aside chiefly or 
wholly for the purpose, to reproduce living young. Without 
this capacity, pedigree and individual excellence count for noth- 
ing. From a practical standpoint, it matters little to us whether 
the failure to reproduce its kind depends upon a want of impreg- 
nation, a failure of union between the ovum and spermatozoon 
or if it be due to the death of the embryo or fetus while yet in 
the uterus, or even to its premature expulsion from the uterus 
in such a defective state of health or development that it cannot 
continue to live ; each results in a defeat of the aim of the breeder 
and practically constitutes sterility. 

We shall here limit our consideration to the failure of the ovum 
to become fertilized by a spermatozoon. The question of the 
life of the embryo and fetus and the birth of the latter in a state 
which will favor its development into a mature animal, we shall 
consider under the head of abortion and related subjects. 

Great variations are noted in reference to the prevalence of 
sterility in our domestic animals, it being, apparently, more com- 
mon in the larger species. There is a somewhat general belief 
also that it is more common in high bred individuals but this may 
be largely erroneous. 

It certainly increases in all animals as domestication and close 
confinement increases, so that it is most common in those animals 
which are kept closely housed and, in this way, it becomes highly 
important in so intensely used as dairy cows. 

With many of our domestic animals, sterility does not attract 
much attention, especially with females, because it makes com- 
paratively little difference to the owner whether they breed, or 
go to the butcher. We are, therefore, most inteiested in steril- 
ity when it appears among animals in which their principal or 
sole value depends upon their reproductive powers. Among 
these, failure to breed may prove a great financial disaster. If 
a large harem of valuable brood mares, kept exclusively for breed- 
ing, is mated for a year with a sterile stallion, no foals are pro- 
duced the following season and a total loss of anticipated income 
results. In addition to this loss, each mare has deteriorated 
119 



I20 Veterinary Obstetrics 

through her increase iu age and, having been idle for a year, has, 
probably, become very fat, the sexual system somewhat weak- 
ened and the tendency to sterility intensified. 

Jn dairy cows, the results of sterility may be equally, or more, 
disastrous. The production of milk is an essentially sexual func- 
tion, enduring, as a rule, but for a year or two, when it may be 
re-established or reinvigorated only by bringing forth young. 
Hence, in a dairying establishment, a failure to breed causes not 
only the loss of the value of the young, but, generally of far more 
importance, a serious diminution in the amount, or total loss of 
the milk. The sterility of a large part of, or an entire herd, is a not 
uncommon observation in the experience of breeders and veter- 
inarians, and, while such instances are very impressive, they do 
not equal in the aggregate, the widely disseminated and oft re- 
peated individual cases. 

If a highly valuable dairy cow fails to produce a calf in a given 
year, the fact is somewhat masked by the success with other 
portions of the herd, but the loss occurs and, add these individ- 
ual instances together, the total cost to breeders becomes enor- 
mous. If a given cow fails to breed for several 5'ears in succes- 
sion, she becomes far more than a total loss, because the owner 
retains her, year after year, in the hope that she may yet breed 
before he sends her to the butcher, where, at best, her value is 
usually trivial. 

The function of reproduction being exceedingly complex, the 
causes leading to sterility are correspondingly varied. 

In higher animals, reproduction can only occur as a result of 
union under favorable conditions of a spermatozoon, or male cell, 
with an ovum, or female pronucleus ; the first elaborated by the 
testicles of the male, the second by the ovaries of the female. 
Anything which may interrupt normal coition of the two sexes, 
or the physiologic activity of either male or female, may end in 
sterility. 

We consequently meet with sterility in both sexes but, in the 
female, the genital apparatus is more complex and sterility more 
common and widely diffused though intrinsically of no greater 
importance than in the male. The function of the male parent 
ends with the ejaculation of healthy semen into the uterus or 
vagina of the female. In the female, there is still to occur the 
migration of the male cells through the uterus and oviducts until 



sterility of the Male Animal 121 

they meet the ovum and, after the fusion of these two cells to 
constitute fertiHzatiou, the female organs must protect, and afford 
nutrition to, the embryo for a long period of time. 

While there are certain analogies between the causes and nature 
of sterility in the two sexes, it is desirable to consider them sep- 
arately. 

A. Sterility of the Male Animal. 

In order that a male animal shall be fertile, it is essential that 
living, virile spermatozoa shall be secreted and that the animal 
be competent to copulate with the female and give effective emis- 
sion to the normal semen. 

The testicles constitute the basis of the male genital sj'stem, 
since they produce the male cell or spermatozoon. In mammalia, 
the testicles are two in number, a right and a left, variably 
located according to species. In all our common domestic ani- 
mals they are normally located in adult life outside the abdomen 
in the scrotum, which is situated, according to species, in the in- 
guinal or perineal region, the testicles passing through the 
inguinal ring in order to reach the scrotal sac. In the elephant, 
the testes are normally retained within the abdomen throughout 
life. 

The testes vary somewhat in form and, necessarily, in size in 
the different .species and present some marked differences in their 
relations. Their general form is oblong or spheroidal and, when 
they come to rest in the scrotum, their long axes may be perpen- 
dicular to the spinal axis, as in the bull, or parallel, as in the 
horse. 

In addition to its peritoneal coverings, the testicle consists of 
its fibrous framework, the proper or secretory tissue, excretory 
ducts, and the vessels and nerves. 

The fibrous framework forms externally a very firm, inelastic 
capsule, the tunica albuginea. This serves to render the func- 
tioning testicle one of the most den.se, incompressible glands in 
the body, the very firmness of which bears an important relation 
to fertility, since any disease causing swelling of the gland 
tends to seriously affect the proper glandular tissue by the severe 
compression. 

From the tunica albuginea, fibrous septa pass toward the center 
of the gland and divide the secretory tissue into small lobules. 



122 Veterinary Obstetrics 

Somewhat near the surface, toward the epididymis, the connect- 
ive tissue stroma becomes very prominent in the central portion 
of the gland to constitute the corpiis Highniori. 

The glandular tissue proper consists of numerous convoluted 
tubules, tubuli semeniferi, which, commencing in a cul de sac,, 
terminate in a central system of canals'. These, passing through 
the corpus Highniori empty into the vasa efferentia, which fin- 
ally converge to form the vas deferens. 

The tubules consist of a basement membrane lined with an 
epithelium of three or four layers of cells. The deeper ones are 
polygonal in form while, more superficially, occur the spermatic 
cells or spermatoblasts, from which, finally, the spermatozoa are 
elaborated, the nucleus constituting the head, while the tail con- 
sists of protoplasm. 

The interlobular connective tissue stroma affords passage for 
the vessels and nerves to every portion of the gland and, within 
it, are numerous interlobular cells, which are believed by some to 
serve as nutritive agents for the tubuli seme^iiferi . 

The seminal canalculi are lined with ciliated epithelium, which 
disappears in the seminal duct, to be succeeded by a single layer 
of epithehal cells. 

The vesiculgs seminales of the stallion consist of two commo- 
dious pouches situated above the urinary bladder and the vasa 
efferentia, communicating with the latter. They have been 
thought by some to act as seminal reservoirs. Hence their 
name. However, it is generally considered that such is not the 
case and that their sole function is the elaboration of a mucoid 
or watery secretion, which becomes mixed with the semen while 
being ejaculated. Fleming (Chauveau's Anatomy) asserts that 
they serve as seminal resevoirs, but investigators, apparently, uni- 
formly fail to find spermatozoa in them. 

The seminal vesicles of the bull have the character of ordinary 
acinous glands. Zschokke has been unable to find spermatozoa 
in them. They have only a very small cavity. 

In the boar, the vesiculae seminales are very large acinous, 
glands, secreting a watery fluid and not containing spermatozoa. 
The vesiculse seminales are absent in the dog and cat. 

The prostate glands of the horse are situated above the ure- 
thra, at the neck of the bladder. They are acinous in type, and 
secrete a transparent viscid fluid, which becomes mixed with 



Sterility of the Male Animal 123 

the secretions of the other glands. In the pig, there are two pros- 
tates, while, in the dog and cat, there is one large gland com- 
pletely surrounding the urethra. 

Cowper's glands are also acinous in character. Chauveau states 
they are absent in ruminants, but Zschokke claims they are pres- 
ent. They are absent in the dog, but present in the cat. 

The physical characters of the secretions from the seminal ves- 
icles, prostate and Cowper's glands varies somewhat, is chiefly 
of a clear, watery character, that from the Cowper's glands being 
somewhat more viscid. They are neutral in reaction. 

The function of the secretions from these subsidiary glands 
has not been very accurately determined, but they apparently 
serve a useful purpose as lubricants and, still more, they dilute 
the secretions from the testicles, adding volume to the semen and 
giving a wider dissemination to the spermatozoa. Furthermore, 
it is believed that their presence invigorates the spermatozoa. 

The semen, at the time of ejaculation, consists of an admixture 
of the secretions from these accessory glands, with the spermato- 
zoa and accompanying fluids from the testicles. It is a whitish, 
viscid fluid of feeble alkaline reaction, and has a specific odor. 

The spermatozoa in this fluid show very vigorous motion, in- 
duced b}^ the contractions of the tail, which cause a progressive 
movement comparable to that of a fish or an eel. Hensen states 
that they may move 1.2 to 3.6 mm. per minute. Their vigor is 
greatest at about the body temperature and is decreased or stop- 
ped by heat or cold or by the addition of water, acids, metallic 
salts, etc., while the vigor of the movements is increased by the 
addition of weak alkalies, blood serum and estrual discharges. 

The commencement of the secretion of spermatozoa marks the 
age oi puberty in the male and is expressed by the appearance of 
sexual desire. Its advent varies greatly according to species, in 
the horse from 10 to 18 months, in the bull from 8 to 10 months 
and in most other species, at an earlier date. 

The amount of semen ejaculated during a single coition has 
not been well determined. In the bull, it is 5-6 c m." (Zschokke) 
and contains more than 60,000 spermatozoa per mm.'* 

In order that successful copulation may occur, it is essential 
that the testicles, excretory ducts, urethra, penis and accessory 
glands be normal in structure and function, and that the locomo- 
tory apparatus be sufficiently normal to enable the male to mount 



124 Veterinary Obstetrics 

the female, and otherwise to perforin the physiologic essentials 
of copulation. 

Sterilit}' of the male niay be outlined as follows : 

I. AZOOSPERMIE. 

a. Congeiiital Defects of Testes. 

1. Anorchidy. 

2. Congenital Malformations and Tumors. 

3. Cryptorchidy. 

4. Hybrids. 

5. Hermaphrodites. 

b. Acquired Diseases of the Testes and Scrotum. 

1. Tumors. 

2. Orchitis and Epididymitis. 

3. Spontaneous Degeneration of Testicles. 

4. Hydrocele. 

5. Torsion of the Testicles. 

c. Asoospertnie from Systemic Disease or Debility. 

1. Debilitating Systemic Diseases, Overwork. 

2. Idleness and Overfeeding. 

3. Excessive Sexual Use. 

4. Onanism or Masturbation. 

II. Defective Secretions of Accessory Glands. 

III. Inability to Properly Copulate. 

1. Arrested Development of the Penis. 

2. Tumors, herniae, etc., near the penis, which serve to mis- 
direct it and prevent its entering the vulva. 

3. Tumors of the Penis and Prepuce. 

4. Penial Paralysis. 

5. Excessive Erection. Spasm of Penis. 

6. Broken or Curved Penis. 

7. Inflammation of Penis. 

8. Adhesions of the Penis to the Prepuce. 

9. Constriction of the Preputial Opening. Phymosis. 

10. Paraph j'mosis. 

11. Lumbar or General Paralysis. 

12. Painful Diseases of the Posterior Limbs and other Parts. 

13. Size of Male. 

14. Age of Male. 

IV. Infectious Diseases. 



Azoospermie 125 

I. Azoospermie. 

In the rearing and selection of male breeding animals, it be- 
comes of importance to determine at the earliest possible date 
whether they may prove efficient sires or not and it is essential, 
first, to know whether they possess normal testicles capable of 
producing vigorous spermatozoa. 

Although these organs, derived from the Wolffian bodies, are 
formed in the sublumbar region, they normally descend into the 
scrotum in all our domestic animals except the elephant and are, 
consequently, with the one exception, quite freely available for 
phj'sical examination. 

In our large herbivorous animals,' these organs normally de- 
scend into the scrotum prior to birth, so that, when one of these 
is born without this having occurred, that fact may well become 
an object for suspicion. 

1. Anorchidy. In some cases these organs are entirely want- 
ing or have been arrested in their development so that they are 
wholly insignificant and devoid of physiologic power. Such ani- 
mals fail to develop sexual desire in the least, do not acquire the 
usual characters of the male in conformation, head, neck, horns, 
voice, or other attributes, but remain neuter or asexual in char- 
acter save in respect to the penis and sheath and even these may 
be defective. No testicles are present in the scrotum and none 
are distinguishable by rectal exploration. On post-mortem ex- 
amination, one may find within the abdomen a mass of tissue 
which, by its attachments and relations, is identifiable as the rep- 
resentative of the testicle, but devoid of any tissue of a true geni- 
tal character. Such are the findings in some twiu calves, as 
well as in some single births, and the same conditions are met, 
far more rarely, among other animals. 

2. Congenital Tumors. In other cases, instead of the normal 
glandular tissue, the male animal is born with a tumor represent- 
ing the genital gland, which may be either teratologic or patho- 
logic. Among the teratologic, the most common are dermoid 
cysts, containing hair, teeth and epithelial debris, along with 
more or less fluid. 

A possible mode of origin of these structures has already been 
discussed on page 12. 

In other animals, the primitive gland may become the seat of 



126 Veterinary Obstetrics 

calcareous deposits, which invade the entire primitive gland and 
efface every trace of glandular tissue, inducing a state equivalent 
to anorchidy. In yet other instances the primitive testicle be- 
comes the seat of a malignant neoplasm. In one case, we ob- 
served in a cryptorchid pig a testicle which was the seat of a ma- 
lignant new-growth which had contracted firm adhesions with 
adjacent loops of intestine. Each of these conditions serves or- 
dinarily to prevent the descent of the testicle into the scrotum. 
The affected organs are necessarily and incurably sterile. Ex- 
cept in cases of malignant disease of the glands, castration is not 
ordinarily demanded. 




Fig. 13. Dermoid Cyst of Testicle 
Showing dental tissues. Horse. ( Hinebaucli. ) 

3. Cryptorchidy also constitutes a uniform cause of sterility 
when both testicles are retained within the abdominal cavity. 
We .speak of abdominal and inguinal cryptorchidy but, ordi- 
narily, only the former may exist as a permanent condition, while 
the latter is a transitory state, in which the gland is descending 
from the abdomen into the scrotum, which it will eventually 
reach. It is only very rarely that inflammatory adhesions or 
other conditions may permanently arrest a testicle in the inguinal 
region during its descent. 

Tj'pically, cryptorchidy is an arrest in the development of the 
testicle, the organ being small, flaccid and soft. Histologically, 
it partakes of the character of the fetal testicle and no sperma- 



Hybrids. Hermaphrodites 127 

lozoa are formed by it. If such a testicle descends and passes 
from the abdomen through the internal inguinal ring, it tends to 
at once develop normally and become fertile. However, it is 
essential that the gland itself shall descend. In some cases, the 
•epididymis descends into the scrotum, while the gland remains 
in the abdomen, the testicle retaining its typical cryptorchid 
character and remaining sterile. While the typical abdominal 
■croptorchid testicle is regularly sterile, it nevertheless induces a 
sexual reflex, causing the development of the ordinary male at- 
tributes, such as the characteristic head, neck, horns and voice 
and usually a sexual desire of an intense and more or less per- 
verted character, in which vice assumes a prominent role. If 
onl}- one testicle is retained in the abdomen, the other being 
normally located and developed or even having undergone com- 
pensatorial hj'pertrophy, the animal may be fertile, that is, the 
normally developed gland is capable of performing its function 
regardless of the presence of the sterile gland within the abdo- 
men. The perverted sexual desire, akin to nymphomania of the 
female, persists so long as one testicle is in the abdomen, even 
though one has descended into the scrotum, and functions. The 
defect is of further interest to the breeder because of its perni- 
cious hereditary transmission from parent to offspring. The con- 
dition is beyond practical remedy. While it is surgically possible 
to procure the descent of the testicle into the scrotum and thereby 
cause the gland to so develop that it will perform its normal 
function, this would not prevent the transmission of the defect 
to the offspring. 

4- Hybrids, chiefly the mule, are regularly sterile, the testi- 
cles partaking of the fetal type histologicall}-, though normal in 
position, form and volume. In this animal, the sexual desire is 
well developed. In rare cases, well authenticated, the female has 
bred, but we do not recall instances of recorded fertility in the 
male, although they' probably occur. The opportunity for the 
demonstration of such power in the male is generally excluded 
by castration. 

5. Hermaphrodites. In all species of domestic animals we 
meet, occasionally, with hermaphroditism in which the two S}'s- 
tems of sexual organs are each found more or less developed in 
the same animal. They incline to assume a prevailing type ac- 
cording to species. 



128 Veterinary Obstetrics 

In the horse, hemaphroditism tends, generally, towards the de- 
velopment of testicles, which are largely retained within the ab- 
domen and attached and located the same as the ovaries, but 
may descend into an imperfect scrotum ; the vulva, vagina 
and uterus may develop almost perfectly, as in one case occuring 
in the clinic of this college (Fig. 54), where the vulva and 
vagina were sufficiently developed that the animal was castrated 
through the vagina in the same manner as mares are spayed. 
The rudimentarj' penis, or enlarged clitoris, usuallj' ends either 
in the vulva or in the vicinity of the ischial arch, with the urethal 
opening directed backwards. In other cases, this organ is pro- 
longed down between the thighs, but, still, as a rule, is directed 
backwards at its extremity. The mammae are usually moderatelj'' 
developed in these animals and, upon casual examination, have 
the appearance of the mare, although, as in one case operated 
upon by us, there were, just above these rudimentary glands, small 
scrotal pouches containing the imperfectly developed testes. 

These animals present chiefly the sexual characters of the crypt- 
orchid horse with all his deranged sexual desire and tendency 
to viciousness. In the case illustrated by Fig. 54, the head, 
neck, voice and disposition were those of a cryptochid horse, and 
the vulva, vagina and uterus were those of a normal mare. When 
castrating the animal, the vagina underwent the customary bal- 
looning, which indicated functional activity. The erectile organ 
occupied a middle place between the clitoris of the mare and the 
penis of the horse. 

In Fig. 14 is shown the generative apparatus of a pig, in which 
the hermaphroditism is of quite a different character, one of the 
glands having developed into a typical ovary, the other a testi- 
cle, the two sides of the genital apparatus thus representing the 
two sexes. 

Sections of these genital glands show one to be a typical crypt- 
orchid testicle with tubuli semeniferi, the other a primitive 
ovary with scattering Graafian follicles containing ova. The 
Muellerian ducts have developed into typical oviducts, uterus- 
and vagina, and, from the Wolffian ducts, have formed typical 
vasa deferentia and the penis is normal in form and extent. 

We have found no records of fertility in hermaphrodites of the 
equine or other species. 



Acquired Diseases of the Genital Organs 129 




Fig, [4. Hermaphroditism. 
Pig. 
T, Testicle. O, Ovar}'. 

P, Penis. CC. Uterine Cornua. 



B. Acquired Diseases of the Testicles and Scrotum. 

I. Tumors. We have already referred on page 125 to con- 
genital tumors of the testicles. 

Malignant tumors of the testicles are occasionally seen in the 
stallion and other adult male breeding animals. When the tes- 
9 



ijo Veterinary Obstetrics 

tide is in its normal position, such a new growth reveals itself 
as a very tense swelling, inclined to be more or less nodular, not 
very painful, but does not tend to cause any marked swelling of 
the surrounding parts. The affected gland becomes sterile as 
soon as the glandular tissue is generall)' invaded and, probably, 
in a large proportion of cases, as soon as any increased pressure 
is exerted upon the parenchj'ma of the gland. 

When tumors of any kind involve the testicle to a marked de- 
gree and determine its loss of function, it should be promptly 
removed for general curative reasons as well as to anticipate 
any unfavorable influence which it may exert upon the other 
gland. 

The prognosis in case of maglinant tumor of the testicle is 
good if the gland be removed early, because the disease tends to 
be confined closely to the gland itself for a considerable period 
of time. The fertilit}' of the normal gland may thus be pre- 
served for an indefinite period. 

2. Orchitis and Epididymitis are not readily distinguishable 
clinically as distinct affections. So far as we are aware, they 
are due to essentially the same causes, present .similar symptoms 
and have like dangers for the fertility of the animal. Judging 
from the standpoint of post-castration observations, it would ap- 
pear that, in the stallion at least, epididymitis is more common 
than orchitis. ( See Fig. 15). 

Inflammations of the testicle and epididymis arise from a great 
variety of causes. In all animals, external wounds are liable to 
cause inflammations of the gland especiall}' when occurring dur- 
ing the active breeding season. Scrotal wounds, especiall}' those 
penetrating the peritoneal sac of the testicle are very liable to 
terminate in an inflammation of the glandular tissue. 

Contu.sions of the testicles without wounds of the skin are 
more or less common in domestic animals and may at all times 
lead to orchitis. In ruminants, and especially in the ram, where 
the scrotum is sometimes large and very pendulous, the testicles 
are bruised by coming in contact with obtacles or by being 
violently struck by one of the hind limbs and thence thrown 
against the other during rapid progession In the stallion, es- 
pecially in trotters used for track purposes, there is a well 
marked tendency for contusion of the testicles to occur by being 
thrown from one thigh to the other when the animal is going at 



Orchitis and Epididymitis 



131 



a rapid pace. When the horse is eniplo3'ed at this work, the 
testicles become more pendulous than when used for breeding. 
Contusions of the testicles of the stallion, and of a very danger- 
ous character, also occur occasionally from kicks by the mare at 
time of service. 

• Orchitis and Epididymitis occur, in some cases, independent of 
any history of traumatism, as an apparently idiopathic malady. 
By some, this is ascribed to excessive venery, or coition. We 
have no definite data to show that it so occurs. It is not improb- 




FiG. 15. Epididymitis. Stai^won. 
T, Testicle. E, Epididj'mis. 



132 J'tic'n'/mrr O/K^/c-Zr/rs 

able that such Lintraced cases are due to infection of some char- 
acter passing through the vas deferens into the testicle, as sug"- 
gested by Zschokke. This may be favored by excessive coition 
or by any debilitating influences. 

In other cases, the disease is directh- traceable to an infectious 
malady. In the stallion, we meet, not infrequently, with sti^an- 
gles abcesses in the testicle or about it. In these, the ordinary' 
symptoms of strangles are usualh' present in other portions of 
the body, such as intermaxillary abcesses, with the other general 
symptoms. In the contagious cellulitis, or pink eye, as we have 
already stated on page 68, orchitis is the rule. Orchitis in the 
stallion has been recorded also as result of glanders. 

In the bull, orchitis occurs as a result of tuberculosis. Zschokke 
(Unfruchtbarkeit des Rindes) records tuberculous orchitis as the 
most common form of inflammation of the testicle in the bull, and 
has observed it both luii- and bilateral. It assumes a chronic 
course. The tubercular nodules are generally disseminated 
throughout the glandular tissue and may extend to the tunica 
albuginea and to the serous membrane. The tubercles present 
their usual characters, with an increased amount of connective 
tissue and greater density of the organ. If the nodules are super- 
ficial, there are adhesions between the two serous coverings. 
Tubercular deposits may also exist in the epididymis and 
spermatic cord. 

The clinical diagnosis of the tuburcular orchitis must chiefl3' 
rest upon the enlargement and hardening of the testicle, its adhe- 
sions, thickening of the spermatic cord and tumefaction of the 
inguinal glands. Other symptoms of tuberculosis are usualh' pre- 
sent and the diagnosis may be verified by the tuberculin test. 

While the sound areas of tuberculous testicles may generate 
normal spermatozoa, it should be remembered that the semen 
emanating from such a testicle will, probably, also carry tubercle 
bacilli, and thus be capable of directly transmitting the disease 
from the bull to the cow. 

Ehrhardt (Schweizer-Archiv fur Tierheilkuude, Vol. 3S, p. 
79^ records a case of orchitis in a bull due to the vesicular vene- 
real disease of cattle. 

Wallruflt ( Reperotorium, iS^6, p. 206) records an epizootic of 
inflammation of the testicles in horses, cattle and goats, accom- 
panied b}- the formation of abscesses. Others record inflamma- 



Orchitis avd Epididymitis 1 23 

tion of the testicles as a result of the presence of nematode 
parasites. 

The anatomy of the testicle is of such a character as to render 
acute inflammation ver}' serious for its functional life. The 
tunica albuginea con.stitutes the most dense and inextensible 
capsule possessed by any gland in the body. When the volume 
of the contents of the capsule is augmented by engorgement or 
inflammation, the pressure exerted upon the encapsulated gland 
tissue is very great and at once threatens its functional activity 
or life. It is, consequentlj', very common for orchitis to per- 
manently destroy the integritj- of the gland. Sometimes, the 
inflammation ends in a total necrosis of the organ. 

From whatever cause orchitis may arise, it should ahvajs be 
treated as a very serious disease, in so far as the reproductive 
powers of the animal are concerned, and should be handled with 
the greatest possible promptness and care. As with all disea-ses of 
the .sexual organs, it is e.speciallj- true of those of the testicles 
that the fundamental principle in their handling should be the 
removal, as far as po.ssible, of all .sexual excitement. The animal 
maybe exercised atd, pos.sibly, benefited thereby, but it should 
be done in a manner to avoid any sexual stimulation. In most 
stallions the application of the stud bridle is in itself a sexual 
suggestion because the animal constantly associates it with 
service. 

So far as possible, a breeding male affected with di.sea.se of the 
genital organs should be removed from .sight or sound of any 
female of his kind, especialh- from those which are in estrum 
Everj' arou.sal of sexual appetite intensifies any existing irrita- 
tion or disease in the sexual organs and successful handling of 
the.se accidents and diseases demands, first of all, sexual quietude. 

Wounds to the .scrotum of male breeding animals should have 
verj' careful surgical attention. Strict antiseptic precautions 
should be taken from the ver3' out.set and continued until all 
danger to the glands has been safel3' passed. If the wound is 
penetrant, infection of the peritoneal .sac is to be ver\- carefully- 
avoided b\- thorough disinfection and closing of the wound. If 
there is a want of good drainage, this should be freeh' provided 
and no accumulation of wound discharges be permitted. The 
food shouldbe of a light, laxative character. 



134 Veterinary Obstetrics 

Contusions of the testicles should be avoided by the removal 
of the causes. Rams with very large and pendulous scroti should 
be confined in enclosures free from rough elevations and from 
obstacles against which the testes may strike when the animal is 
moving about and should be guarded against being chased by 
dogs or otherwise compelled to run. Injuries from contusions of 
the testicles of trotting or pacing stallions are effectively obviated 
by the use of a stallion suspensorium. The protection of the 
testicles of the stallion against kicks or other contusions during 
service has already been considered on page 51. 

Purgatives should usually be administered in cases of acute 
orchitis unless contra-indicated by some general systemic disease 
like pink eye. Even then, it would probably be desirable to 
prescribe such hypodermic cathartics as arecoline or eserine, 
combined with pilocarpine, which will act quickly without caus 
iug any great depression or inducing super-purgation. They 
should be given in small doses and maj' be repeated, if necessary, 
in one hour. In such animals as have pendant testicles, it is 
advisable to apply a suspensory bandage, which favors the circu- 
lation within the organs and tends to overcome the congestion. 

Locally, cold water may be applied to the testicles, or, when 
this cannot be continued, it may be advantageous to use an oint- 
ment or liniment consisting of camphor, belladonna and olive oil, 
applied with abundant and repeated massage. 

Febrifuges may be used to lower the temperature in event of 
fever, but, since any elevation of temperature will usually sug- 
gest, if not indicate, the presence of infection in the gland, in- 
ternal medication should be chiefly directed toward the elimina- 
tion of the infecting element itself or of the products of infection. 
For this purpose, eserine and pilocarpine and, to a much less 
degree, the slower acting cathartics, exert a beneficent influence. 
Potassium iodide in full doses not only serves to favor the elimi- 
nation of bacterial products, but tends to exert a distinct bacter- 
icidal action. Some writers advise against its use lest it cause 
atrophy or degeneration of the testicles but, so far as we are 
aware, there is no evidence of such action of the drug in domestic 
animals. 

Hoffman recommends compression of the testes of dogs by 
means of strips of adhesive plaster over the scrotum, thereby 
tending to support the circulation in the part. When abscesses 



Spo7itaneous Degene^'ation of the Testicles 135 

occur ill the organ, they should be promptly opened, the pus 
evacuated and the cavity treated antisepticallj'. 

Castration is always to be considered in case of orchitis, whether 
acute or chronic. In cases of acute orchitis or epididymitis in- 
volving one gland only, there is a constant tendency for the other 
to become involved. If the life of the animal is threatened by 
the intensity of the inflammation, if the function of the gland is 
apparently wholly and permanently destroyed, or if there appears 
to be danger of the sound gland becoming involved, the removal 
of the affected testicle .should occur without delay. In chronic 
recurrent orchitis of both testicles, especially if examination of 
the semen indicates the absence of spermatozoa or if the animal 
has proven sterile in the stud, total castration should be per- 
formed and such salvage obtained from the animal as conditions 
may permit. 

In animals affected with acute orchitis, there is some hesitancy 
at times about castration lest the patient cannot well endure the 
operation but, in our experience, it is a most efficient therapeutic 
agent and the operation at once improves the general well-being 
of the animal. When orchitis is present as a complication of an^ 
acute infectious fever, like " Pink Eye,'' we should regard cas- 
tration as unsafe, until the acute stage of the malady has run its 
course and the disease has become chronic and located chiefly or 
wholly in the testes. Since, in orchitis, there are usually intimate 
and extensive adhesions between the peritoneal layers, it is safer 
and more convenient to castrate by the covered operation. The 
removal of one of the testicles, providing the other is sound, does 
not interfere with the reproductive power of the animal. 

3. Spontaneous Degeneration of the Testicles. Zschokke re- 
cords spontaneous degeneration of the testicles as a not uncommon 
cause of sterility. He attributes it largely to the action of toxines 
upon the secretory cells of the organ, thus causing their destruc- 
tion. He assumes that these toxines reach the glands through 
the blood or lymph, during the course of some systemic di.sease, 
in which the deleterious poisons are generated, and that the effect 
of the,se toxineswill be most noticeable upon those tissues which are 
most sensitive, among which are the secretory cells of the testi- 
cles. When these toxines act upon the spermatoblasts, their 
first effect is the destruction of their physiologic function. If 
the toxicity is slight and temporary, the cells soon recover their 



136 Veterinary Obstetrics 

function, bnt, if intense and continuous, it leads to disease changes 
and death of the cells. 

The anatomical changes observed by Zschokke under these 
conditions in the testicles of bulls, without apparent external 
cause or symptoms, accompanying the sterility, were now and 
then, sclerotic connective tissue degeneration ; fatty infiltration ; 
and the formation of bone, or the total calcification of the sem- 
inal tubules. He asserts that calcification is not at all rare and 
that it is easily recognized upon a microscopic examination of 
the excised gland, the white, calcified tubules being easily visi- 
ble and evident to the touch. The diagnosis of this condition 
cannot be made by palpation in the living animal with the or- 
gans in position, or by other means than histologic examination 
of the excised gland, except by examining the semen and deter- 
mining the absence of .spermatozoa, which would point with con- 
siderable certainty to a degeneration of this character. It is evi- 
dent that no method of handling can result in any restoration of 
the breeding power, under such conditions, and castration is in- 
dicated. 

4. Hydrocele, or dropsy of the scrotum, in which there is aft> 
accumulation of fluid in the scrotal sac between the two peritoneal 
layers, probably, exerts an unfavorable influence upon the af- 
fected glands and tends to produce sterility. If the accumula- 
tion of fluid in the sac is the result of a general dropsy of the 
peritoneal cavity, ascites, the systemic debility of the animal 
would usually determine sterility. When the affection is local, 
as is usually the case in the .stallion, and depends upon a chronic 
inflammation of the scrotal peritoneum with the accumulation of 
the secreted fluids in the sac and involves but one organ, it may 
not induce ^complete sterility, but affect the formation of 
spermatozoa in the diseased testicle only. 

The symptoms of hydrocele consist of a painless enlargement of 
the scrotum, appearing gradually and usually without recogiza- 
ble cause. The general health of the animal is not usuallj^ in- 
volved. The swelling is even, soft and suggillating, indicating that 
it consists of fluid. It is to be differentiated from tumors and 
orchitis by the firmness of the latter ; it may be distinguished 
from hernia by rectal exploration, determining, thereby, the 
presence or absence of a segment of the bowel in the internal in- 
guinal ring. Its diagnosis may be further established by intro- 



Azoospermie from Systemic Disease 137 

trodaciug an exploratory trocar and withdrawing a portion of 
the contents. 

The handhug of hydrocele is not usually highly successful. 
Sometimes good results may be had by aspirating the fluid and 
injecting tincture of iodine or Lugol's solution into the cavity. 
When these measures fail, a radical cure of the local disease may 
be brought about by castration, the covered method being used. 
When the hydrocele is dependent upon a general constitutional 
malady, with dropsy of the abdomen, there is, usually, no suc- 
cessful method of treatment. 

5. Torsion of the testicles, it is claimed, operates at times to 
cause their atrophy and inhibit the formation of spermatozoa 
because of interruption of their nutritive supply. The reversal 
of the testicle of the stallion, so that the tail of the epididymis 
is turned forward, is alleged to interfere with fertility. Such a 
result from this slight and common displacement is, probably, 
purely mythical. It is well known that emasculation can be 
produced in ruminants by the process known as double subcu- 
taneous torsion, in which the testicles are twisted and turned 
upside down in a manner which interrupts their vascular supply 
and induces atrophy, with disappearance of sexual desire and 
power. 

c. Azoospermie from Systemic Dlsease. 

I. Debilitating Diseases and Overwork. Any constitu- 
tional disease which produces profound depression of the general 
system is usually accompanied by suspension of the powers of 
reproduction. Most serious constitutional disorders not only de- 
stroy the sexual desire for the time being, but also prevent the 
formation of spermatozoa and thus lead to essential sterility dur- 
ing the period of the existence of the disease. In some acute 
fevers, the sexual powers are not in complete abeyance and male 
animals affected with a disease accompanied by a high fever may 
be fertile. In one case, we observed a stallion affected with 
brustseuche, with a temperature of 107° F., which, in spite of 
the very high fever, served a mare and successfully impreg- 
nated her. 

In chronic debilitating diseases, there is sometimes seen a 
tendency to sterility, especially in the constitutional bone dis- 



138 Veterinary Obstetrics 

eases, like osteoporosis, rickets and in other chronic disorders 
which depress the general vigor of the animal. 

Overwork serves to inhibit the breeding functions, so that 
animals subjected to severe work are strongly inclined to be 
sterile for the time. In animals which are severely, but not over- 
worked, as in stallions which are being trained for the turf, 
there is usually a temporary sterility, without any evidence of 
disease or degeneration of the glands. The resources of the 
animal are whollj- consumed in the physical work which is 
demanded and there remains no reserve force to provide repro- 
ductive energy during this period. 

Starvation has a like effect upon the reproductive powers so 
that anj- animal which does not receive suflBcient food to main- 
tain the general vigor of the sj'stem and afford a moderate re- 
serve for reproductive energies tends to become sterile during 
the period of want. 

The remedies for these conditions are suggested b}^ the causes, 
they are usually but temporary and run a parallel course to the 
causes themselves. Whenever these are removed or naturally 
cease, the reproductive powers become spontaneously restored. 

2. Idleness and Over-feeding. Impotence of the male is 
frequently expressed chief!}' by an absence of sexual desire, 
without an}' changes of the sexual organs which can be detected. 
The male shows but slight sexual desire or none at all in the 
presence of females which are properly in estrum. At one time 
he ma}' pay some attention to the female, with a more or less 
complete erection of the penis, and then desist in his attentions,, 
and turn away. When the next female is presented, he may 
show normal sexual vigor. 

In some cases, there is alleged to be an individual psychic in- 
fluence which prevents the male from copulating with a certain 
female. This is alleged to be especially true of some stallions, 
to which certain mares seem to be repulsive, and they refuse ta 
serve them. The presence of young at the side of the dam is 
sometimes alleged to repress the sexual appetite of the male. This 
is usually seen, however, only in those males depressed in their 
vitality by improper handling. It is almost, if not always, 
erroneous to attribute this trouble to the caprice or idiosyncracies- 
of the male by which a female of a certain type or color becomes 



Restdts of Idleness and Overfeeding 1 39 

repulsive to him and fails to arouse his sexual appetite ; the real 
cause lies in bad management. 

In some cases, there is a general depression of the sexual de- 
sire, especially in those animals which are lethargic or of a 
phlegmatic temperament. In very active, nervous animals this 
peculiarity is rarely seen. It is most common in draft stallions, 
but is observed in bulls, especially of the beef breeds, and in all 
kinds of male breeding animals. 

The tendency to loss of vigor on this account increases with 
the age of the animal. It is usually not noticeable in the young, 
but, as soon as the animal has become mature and grown quite 
fat, the disposition becomes marked. This form of impotence is 
seen almost exclusively in those animals which are closely con- 
fined, highlyfed and not properly exercised. It tends to disappear 
promptly upon a correction of the method of keeping, providing 
that it be applied sufficiently early. The most careful search 
fails to find any anatomical reason for the difficulty, and it seems 
to be of a purely functional character. The difficulty should be 
prevented by not forcing the young male designed for breeding 
purposes too rapidl)' in his development, but bj' allowing him 
only a moderate diet, with plenty of exercise and freedom, and, 
whenever practical, permitting him to consort with females dur- 
ing his period of growth. 

Upon the appearance of these defects in the mature animal, 
much can be done, if handled opportunely, by restricting the 
diet and causing an abundance of exercise. In our experience, 
a healthy draft stallion refused almost wholly to serve mares. He 
was being highly fed and was getting a very limited amount of 
exercise, at a slow walk. Being appealed to for advice, we re- 
duced his food ration one-half and prescribed eight miles exerci.se, 
daily, at a brisk walk. Within a few days, his sexual desire had 
fully returned. He finished his season's work in good form, 
and was effective as a sire. The same general principles apply 
to other breeding males. In countries where cattle are habit- 
ually worked, the bulls are largely kept in breeding condition by 
moderate draft service. It might be well to imitate this plan in 
America, where they are not habitually used for work purposes, 
but could readily render considerable service, while being greatly 
benefited by the vigorous exercise which would be secured in 
this way. Under general conditions, it is perhaps the best pos- 
sible and most economic manner in which we can insure sufficient 



140 Veterinary Obstetrics 

exercise for these animals. Incidentally, it should be noted that 
such exercise or work tends very strongly to prevent that vicious- 
ness in bulls and other breeding males, which renders them dan- 
gerous to their keepers. 

Zschokke emphasizes the value of the proper selection of food 
for the purpose of arousing a sexual desire and especiall}' insists 
that the hay should be of an aromatic character, as should also 
the oats. Not only .should they be well cured and sweet smelling, 
but he believes that the admixture of certain stimulants like 
calamus, pepper, powdered mustard, and even powdered canthar- 
cides, are advantageous. He recommends that these remedies 
should be fed with cut ha}' and should be allowed for two or three 
days in succession and then omitted for a like period, when they 
may be given again. 

We doubt very greatl}' the value of aphrodisiacs, or sexual 
stimulants, in breeding animals. Sexual instinct is so normal a 
phenomenon and so universal in animals of breeding age and 
proper health that we fail to see the value of exciting sexual de- 
sire artificially. The function belongs normally to every male or 
female of breeding age and, if it is absent, it is because of .some 
depression in the general vigor of the animal, which cannot read- 
ily be removed by aphrodisiacs. It has not been shown that the 
arousal of sexual appetite by means of these drugs insures or even 
favors fertility. A constant and wide distinction must be drawn 
between copulation and fecundation. The fundamental function 
of the male is the elaboration of virile spermatozoa or male cells, 
while copulation merely serves to transfer these fecunding cells 
from the testes of the male to the vagina of the female. Copu- 
lation is in vain without vigorous spermatozoa and we have no 
data to show or suggest that any drug may directly cause or favor 
their development. 

Certainly, we must admit that tonics, alteratives, or other 
drugs which are capable of favorably influencing the restoration 
of a diseased animal to a healthy state must also improve its re- 
productive powers by restoring the equilibrium of the body and 
enabling it to better perform all its normal functions, among 
which is reproduction. The highest state of the general vigor of 
the body is, consequently, the most favorable condition for the 
production of virile spermatozoa, which constitute the first essen- 
tial in the fertility of the male animal. 



Results of Idleiiess and Overwork 141 

Zschokke further remarks that there is sometimes an absence 
of sexual desire in young bulls which have not previously served 
cows. This seems to bean absence of the sexual instinct and he 
suggests that such animals should be turned loose with cows 
which are in estrum. Under these conditions, they soon become 
sexually awakened and learn to serve females. This difficulty is 
not so prominent in other domestic animals, though the same 
condition is observed to some extent in young stallions. Under 
normal conditions the sexual desire of healthy young animals is 
awakened and intensified by the presence of the opposite sex. 
Breeders of pedigreed stock recognize this fact and cautiously keep 
young males of some species entirely away from females which 
may be in estrum, lest their mere presence awaken the sexual 
desires of the immature male and thereby interrupt his growth. 

The preparation of breeding animals for the show ring is always 
verj' dangerous for the sexual vitality of the individual. In order 
to get them in high condition, they are frequently closely con- 
fined in the stall and fed in such a manner as to produce the 
greatest amount of fat, in order that they may make a better 
showing and more certainly win a prize. It is an unfortunate 
fact that many of our most richly bred animals, which are de- 
signed for breeding purposes and which capture the most coveted 
prizes at the livestock fairs, have their breeding powers either 
temporarily or permanently destroyed in the process of feeding 
them for the show. There is no effective method for overcoming 
this except by the exercise of greater intelligence on the part of 
the owners of show animals, which may be furthered bj^ judges 
in livestock exhibitions paying less attention to the amount of 
fat and more to the form and general vigor of the animal, in the 
allotment of premiums. In order to show breeding animals with 
safet}', it is absolutely essential that abundant exercise should 
accompany the preparing process if the .sexual vigor of the animal 
is to be safely preserved. 

The result is not the same with all individuals. There are 
some which can withstand almost unlimited abuse in this direc- 
tion and continue to breed regularly, while others are very sus- 
ceptible and soon become temporarily or permanently sterile. 
Once this sterility is established, the only thing that can be done 
is to correct errors in care by moderating the diet and enforcing 



1 42 Veterinary Obstetrics 

vigorous exercise, which will, as a rule, though not always, re- 
store the sexual powers. 

In a general way, the food of a breeding male needs be rich in 
protein, as compared with the amount of hydrocarbons and car- 
bohydrates. The most common foods, when well grown and 
cured, are the best for the breeding animal, such as bright, aro- 
matic hay and clean, well developed oats, along with grass, to 
which may be added, in the winter, roots and tubers. Rarely, 
if ever, is it necessary or even advisable or permissible to add to 
the food any sexual stimulant like pepper or mustard. 

3. Excessive Sexual Use. The number of services which 
a male animal can effectively render is an important question for 
the breeder. It probably varies greatlj' with different indi- 
viduals. Naturally, the power of a male does not rest so much 
upon the number of females which he is expected to serve as 
upon the number of copulations essential to cause fertilization. 
It has been determined by careful investigation that, when the 
number of copulations during a given day is increased, the 
abundance of spermatozoa in the semen rapidly decreases and, 
if this service is pushed too far, the spermatozoa fail almost en- 
tirely, causing an interruption of the fertility of the animal. 
Much will depend upon the age and vigor of the male animal. 
Zschokke states that 80 to 100 cows may be bred to a single bull 
when the animal is kept confined and his service somewhat regu- 
lated by the breeder but, if allowed to consort with the cows at 
pasture, not more than 50 should be allowed. In the western 
range country of America, the allowance is very much smaller 
and it is con.sidered safer that there be one bull to each 20 or 25 
cows. This is necessitated largely by the fact that, during the 
principal breeding season, the bulls have not yet fully recovered 
their vigor from the long and trying winter with scant food sup- 
ply. Zschokke further holds that the bull should not be allowed 
to serve more than three cows in any one day and that, under 
such conditions, there should be one or two days per week of 
complete rest. 

In the stallion, similar rules as to numbers and conditions are 
applicable. The total number of females, however, may be 
greatly increased over that suggested by Zschokke, if the service 
is distributed throughout the year, and noted stallions have been 
known to serve successfully, and without apparent injury, two 



Onanism or Maseurbation 143 

or three hundred mares during the year but, in such cases, the 
service was evenly distributed over the entire period. 

Zschokke draws attention to the erroneous belief that a long 
abstinence from coition serves to store up a large amount of se- 
men, which will answer for a series of copulations. There is no 
reservoir in the animal body for such purpose, and all semen 
which mav be secreted and not used in copulation soon disinte- 
grates and is expelled or absorbed. On the other hand, he points 
out that, perhaps, the glands undergo some atrophy from long 
inactivity and that their function is best preserved by moderate 
use. 

Excessive sexual use is largely a comparative term and indica- 
tive rather of a relative over-use under surrounding environment. 

There is no question that a breeding male may be readily over- 
done, nor that such is not a frequent occurrence, but, more com- 
monly, the use-becomes excessive under bad management, where 
proper handling of the male would enable him to make the num- 
ber of services demanded, safely and efficiently. 

Zschokke also draws attention to the very important fact that 
moderate work during the breeding season is not injurious, but 
favorable, to fertility and that permanent confinement in the 
stall tends contantly to a decreased secretion of semen and con- 
sequent sterility. It is a constant observation that a male breed- 
ing animal which is regularly exercised is capable of rendering a 
greater number of effective services than one which is closely 
confined. 

The feeding has much to do with the breeding capacity of the 
male. In quality, some writers condemn such foods as oil cake 
and malted grain and prefer the various forms of grains and, es- 
pecially, of oats, barley, peas and beans in moderate quantity. 
To these should be added hay and grass in sufficient amount. 
Roots, tubers, meal and molasses are not essential as a part of 
the food supply for breeding males, but may aid in maintaining 
a good state of digestion and thus contribute to the general vigor. 

The feeding of salt has long been regarded as important in 
reference to fertility, but it is not known whether it acts directly 
or merely serves to favor fertility, indirectl}', by aiding digestion 
and assimilation. 

4. Onanism or Masturbation. Masturbation, as a cause of 
sterility, is observed chieflj^ in the stallion and bull. It is very 



144 '[■'eterinary Obstetrics 

common in improperly kept stallions. Spinola (Handbuch der 
spec. Pathol. 1858, II Bd.) records this vice in the bull. 

The stallion has an erection, the penis is moved up and down, 
imitating coitus, until finally an ejaculation of semen occurs. In 
the bull, the ejaculation is induced by an erection and the alternate 
protrusion and withdrawal of the penis. This is largely seen in 
idle males which are closely confined, over fed and sparingly used 
for breeding and in track stallions when sexual debility is 
brought about b}' hard work. It is a question whether the 
Onanism causes the impotence or the sexual weaknesses induces 
the masturbation. 

Corrections ma}' be brought about by such feeding, exercise and 
other care as will maintain the general vigor of the animal and, 
as far as possible, he should have something to divert his atten- 
tion and exert a favorable ps}'chic influence. Moderate work or 
exercise and judicious feeding, or, in animals which cannot be 
worked or artificalh' exercised, the allowance of freedom in a 
commodious paddock, or, still better, in a properly enclosed past- 
ure, and especially in compan)- with pregnant females, tends 
largeh- to prevent or cure the' vice. Once the habit has become 
fixed, it should be prevented bj^ a shield so arranged as to cause 
pain whenever the penis is protruded and thus prohibit erection. 
It is to be constantly viewed as a vice of idleness and debility, 
and it must be remembered that any and all remedies must fail 
in their aim until the return to normal vigor is attained. 

II. Defective Secretions of the Accessory Gl.\nds. 

Ba,ss and Furbinger (Deutsche Zeitschr. f. Th. Med. B. XX. 
page 147) claim that the absence of the prostate secretions leads- 
to an immobility and loss of vigor in the spermatozoa. The gen- 
eral belief of investigators is that the secretions of all the acces- 
sory glands — the seminal vesicles, the prostate and Cowper's 
glands — when added to the semen, tend to stimulate the move- 
ments of the spermatozoa, invigorating them and prolonging their 
life, thus acting as an important accessor}' in the phenomenon of 
fertilization. How often sterility may be due to disease or im- 
proper function of these glands is not known. 

III. Physical Inability to Copulate. 

I. Arrested Development of the Penis, which we have al- 



Tumors. Paralysis of the Penis 145 

ready noted on page 127 as occurring frequently in hermaphro- 
ditic animals, especially in the horse, is not rare in foals which 
are otherwise apparently normal, and similar defects may occur 
in other animals. In these animals, copulation may be impossible, 
either from the smallness of the organ or its misdirection. The 
defect is usually not subject to correction, nor is it desirable to 
correct it, lest the malformation prove transmissible. 

2. Tumors or Herniae situated about the opening of the 
sheath may tend to push the penis aside as it is protruded and 
thus to so misdirect the organ that copulation becomes uncertain 
and difficult, if not impossible. 

3. Tumors of the Penis or Prepuce in male breeding ani- 
mals are not rare, and constantly tend to interfere with, or pre- 
vent, copulation. 

We have already, on page 104, alluded to the infectious granulo - 
mata or lymp ho- sarcoma upon the penis of the dog ; on page 112, 
to bursattee of the genitals of the horseand, on page 113, toactino- 
mycosis of the genitals of the btill. Various types of tumors, both 
benign and malignant, involving the penis or prepuce, are not rare 
in the stallion, bull and other males. The}' are quite largely of 
papillomatous type and, as soon as they attain a moderate size, 
prevent copulation. Their usual seat is upon the glans penis, 
where they are easily diagnosed by examining the exposed organ. 

In all cases, their removal should occur early, ere they involve 
the organ to such a degree that their ablation will result in its 
serious mutilation. In the stallion, the glans penis may be am- 
putated and the copulatory and procreative powers fully retained. 
In the bull, with the long, tapering glans, amputation is not 
practical, since copulation is thereby rendered difficult or impos- 
sible. In breeding males, the early ablation of penial tumors 
consequently becomes very urgent, if their breeding powers are 
to be retained. 

4. Paralysis of the Penis occurs in all animals, but espec- 
ially in the stallion. It is usually of central origin and frequently 
occurs as a symptom of a constitutional affection, like the so- 
called cerebro-spinal meningitis, dourine, etc., and is a common 
accompaniment of lumbar paralysis, or of injuries to, or diseases 
of, the internal pudic or great sympathetic nerves. It is rarely 



146 Veteri7iary Obstetrics 

remediable, and depends for its recovery upon the removal of 
the cause. 

In other cases, the paralysis is local and more or less tem- 
porary in character. Any injury to the penis which causes swel- 
ling and inflammation tends to induce paralysis, both directly 
through the disease of the tissues and indirectly as a result of 
the dragging on the organ due to its increased weight. Rough 
handling by the groom or violent strains of the organ during 
copulation may also lead to paralysis. Large tumors on the 
penis, by their weight, tend to cause paralysis and prolapse of 
the organ. In penial paralysis, the protruded organ is further 
exposed to wounds, abrasions and, in cold weather, to freezing. 

The handling of penial paral3'sis in breeding males should be 
prompt and energetic. The paralyzed organ should be at once 
supported, in order to overcome the injurious results of pend- 
ency. In recoverable ca.ses, the longer the penis protrudes, the 
greater the danger that the prolapse itself may lead to permanent 
paralysis of the organ. 

5. Excessive erection of the Penis (Spasm) sometimes 
occurs in the stallion and possiblj' in other animals. It is ac- 
companied by a peculiar interruption of copulatory power, closely 
analogous to the vaginisimis of the female. We have personally 
observed one case in the stallion and have known of a second, 
both imported French draft horses. These stallions were very 
amorous and would quickly get an erection, the glans penis becom- 
ing excessively large. They would promptly mount mares, intro- 
duce the penis momentarily into the vulva for a short distance, 
suddenly withdraw it and dismount with the penis still fully 
erected and without the ejaculation of semen having occurred. 
Repeated efforts were unavailing and constant and prolonged 
failure to copulate resulted. Zschokke records the case of a bull 
(Unfruchtbarkeit des Rindes, page 58} in which the symptoms 
were somewhat similar. 

Careful examination fails to reveal any anatomical defect 
or pathologic changes. The diiEculty appears to be wholly 
functional. 

No remedy is certainly known. Vigorous work on a light, 
laxative diet may be tried. We attempted to overcome the 
nervous irritability by means of potassium bromide, but failed. 
Possibly we did not give a sufficient quantity. The horse passed 



Broketi Penis. Inflani7natio7i of the Penis 147 

from our observation before we had an opportunity to fully 
investigate. 

6. " Broken Penis." When the penis becomes violently 
and abruptly bent while erected, the tissues at the point of cur- 
vature become severely injured, inflammation and swelling occur, 
the erectile tissues become infiltrated and undergo sclerosis. 
After a tardj' recovery, distortion remains ; the penis is bent or 
curved. In addition to the deformity, there is sometimes an in- 
terruption of the vascular or nerve supply to the portion of the 
penis distal to the seat of the injury and, in this part, erection 
may be wholly wanting, while nornral in the proximal portion of 
the organ. The deformity and want of erection in the distal 
portion serves to prevent copulation. • 

Treatment is usually impracticable. The defects cannot, as 
a rule, be remedied and generally occur too high to permit of 
successful amputation from a breeding standpoint. In some 
cases of broken or curved penis, where copulation was still pos- 
sible, sterility is claimed to have resulted because the semen 
ejaculated from the bent organ was thrown laterally against the 
side of the vagina instead of forwards against the os uteri and 
the spermatozoa failed to enter. The difficulty in such cases 
was apparently' overcome by artificial insemination, the semen 
being collected from the posterior portions of the vagina and 
introduced into the os uteri. 

7. Inflammation of the Penis may arise in a variety of 
ways. We have already referred to the Venereal Infections 
which generally lead to more or less inflammatory disease of this 
organ . 

In addition, inflammation occasionally results from physical 
injuries during coition, from kicks in stallions, from lacerations 
when breaking from enclosures while the penis is erected, from 
the tail hairs of the mare becoming caught by the penis and 
cutting it, by the " hanging fast " of the dog during copulation 
and in many other ways. 

The effects of inflammation of the penis upon copulatory 
powers varies greatly. Some males, like the bull, affected with 
one of the venereal diseases, may copulate in spite of the fact 
that the process causes profuse hemorrhage from the penis, which 
must be accompanied by pain. The stallion with bursattee of 
the urethra proceeds to copulate regularly, although he bleeds 



148 I'^eteririary Obstetrics 

freeh- after each sendee. In this case, as in bursattee of other 
parts, there is usually, no e^^dence of pain. At other times, 
moderate inflammation of the penis ma}- cause a male to desist 
from coition, although the sexual appetite is unimpaired and 
erection occurs ; in others, the inflammation inhibits erection. 

Inflammation of the penis should be promptly and energet- 
icalh- handled, not onl}' that we maj- therebj- cause its eventual 
subsidence, but also to anticipate and avoid deformities and par- 
alj'sis. In general, the handling is to be based upon antisepsis, 
combined with astringents and cold, not neglecting to effectivelj' 
support the organ, retaining it within the sheath if possible. 
The patient should be removed from sexual excitement and anj^ 
internal medication which conditions suggest applied. Should 
the inflammation be acute and the swelling great, no time should 
be lost in inducing prompt catharsis by means of eserine, areco- 
line or other drugs of this group ; delay in awaiting the action of 
aloes or oil ma}' prove serious. 

8. Adhesions between the Penis and Prepuce are 
especially liable to occur in the bull and other male ruminants, 
and constitute very serious obstacles to copulation. Resulting 
usually from some chronic inflammation of the penis and prepuce, 
the contiguous mucous layers, their protective epithelium having 
been destroyed, adhere in such a manner as to prevent protrusion 
of the penis. We have observed such a case in a valuable bull. 
Where possible, the adhesions should be surgicall}- overcome and 
their recurrence prevented but, as a rule, they are not subject to 
remedy. 

9. Phymosis occurs in various animals as a result either of 
tumors or enlargements of the glans penis, which prevent its 
passage through the normal preputial opening : more generalh', 
the preputial opening becomes narrowed by inflammatory pro- 
cesses, possibly intensified hy the deposit of urinary salts and 
epithelial debris. Naturalh', it is most liable to occur in the 
ruminant and the dog, with narrow preputial openings. It is 
rare in the horse, where the opening is ver}- ample. 

In the bull, it is liable to ensue from the deposit of urinary- 
concretions in the sheath, as a complication of intense preputial 
inflammation, with great swelling. It is readily recognized b}' 
the pain, heat and swelling of the parts, and the very fetid pre- 
putial discharge. 



Paraphyniosis. Lumbar or Gejieral Phymosis 149 

The handling of phj'mosis consists essentially of the control of 
the infection which has caused it. The prepuce and sheath need 
be thoroughly and repeatedly douched with a warm antiseptic 
solution, not too powerfully irritant, such as a )<^ % solution of 
potassium permanganate, or a i % solution of carbolic acid or 
creolin. The solution should be used in large volume so that 
the sheath and prepuce are repeatedly filled until the entire 
cavity is thoroughly cleansed and disinfected. In the bull, the 
preputial tuft of hairs' should be removed in order to facilitate 
cleansing. 

When the preputial opening is too greatl}' constricted, espe- 
ciall5^ in the bull, so that clean,sing the cavity through the normal 
opening is difficult or impracticable, the sheath is to be freely 
opened, either by surgical enlargement of the preputial opening 
or by a perforating incision through the inferior wall of the 
sheath at its posterior extremity. The latter method affords ex- 
cellent facility for thoroughly cleansing the narrow, elongated 
sheath of the bull. With the latter plan, the antiseptic fluid 
can be injected through the preputial opening and allowed to 
escape through the incision at the posterior extremity of the 
sheath. 

10. Paraphymosis, or the protrusion of the penis through an 
incarcerating preputial opening, interferes with normal erection 
and copulator)- power. The incarcerated glans penis becomes en- 
gorged, swollen and inflamed so that it is too painful to permit of 
copulation, and functionally incompetent. 

Observed chiefly in the dog, it more frequently follows than 
prevents copulation, but, having occurred, prevents coition until 
remedied. It is to be remedied by a reduction of the paraphy- 
mosis. The incarcerated glans penis is, usually, greatly swollen 
and exceedingly painful and cannot be readily returned to its 
position. After cleansing with tepid water, to which a little 
lysol or soda bicarbonate has been added to render the parts unc- 
tuous, the enlarged glans is to be decrea.sed in volume by digital 
compression and finally pressed back through the preputial ring. 
Failing in this, the preputial opening needs be dilated by a .small 
incision with a probe-pointed bistoury, enlarging the opening 
just sufficiently to permit the return of the glans. This may be 
followed by antiseptic dressing. 

11. Lumbar or General Paralysis, as a bar to copulation. 



150 \^eterinary Obstetrics 

is most frequent in the stallion, but is possible in all males. We 
have already referred to the paresis of Dourine as rendering the 
stallion unable to mount the mare. 

Usually, when any marked lumbar or general paraU'sis is pres- 
ent, the male is unable to mount the female and, hence, fails to 
copulate. In many cases, parah'sis of the penis, to which we 
have already referred, accompanies these affections and also 
serves to inhibit copulation, even if the animal be able to mount 
the female. 

Usually this group of affections is not subject to cure or allevia- 
tion and can be successfully handled only in those extremeh' rare 
cases where the cause is removable. 

12. Painful Diseases of the Feet and Limbs or of other 
parts, which may cause great suffering during coition, serve to 
render copulation uncertain or to prevent it. Diseases of the 
bones, like osteoporosis, spavin, ringbone, or painful diseases of 
the hind feet, such as wounds, quittor and others, serve to cause 
great and even unendurable pain when a male, like the stallion, 
is compelled to bear his chief weight on the two posterior mem- 
bers while mounting the female. Aside from this difficulty, in 
some of these there is a decreased formation of spermatozoa as 
well, owing to constitutional disturbances and loss of general 
vigor. 

13. Diseases or injuries along the inferior part of the chest 
or abdomen, so situated that they come in contact with the fe- 
male during the act in a way to cause great pain to the male, 
tend to cause hiin to desist from attempts at copulation. 

Their prognosis will varj- greatlj- according to cause, being 
favorable where the latter can be removed, unfavorable and per- 
manent where the causes are fixed. 

The handling is along general surgical lines according to con- 
ditions. 

14. Over Size of the male apparently acts as a bar to copula- 
tion in some cases. An old bull may become so heavy aud fat 
that it becomes difficult for him to mount cows. Zschokke also 
suggests that overfilling of the rumen may so weight a bull as to 
render his mounting a cow exceedingly difficult. The nature of 
the condition, itself, indicates the rational method of handling. 

15. The Age of the male, especially as related to size aud 
maturity, may affect his ability to copulate. We have already 



Infectious Diseases. Examiiiation of the Male 151 

referred to the danger to small or young bulls in attempting to 
serve mature cows of large size. If this disparity in size be too 
great, copulation may be not only unsafe but even impossible. 

With an undersized young male, care should be taken to give 
him an advantage in the breeding place. The hind feet of the 
cow should rest upon lower ground than that upon which the 
bull stands and the ground should be drj- and of a character to 
afford secure footing. The breeding stocks recommended by 
Zschokke and briefly described on page 61 may here be used 
with benefit. 

IV. IxFECTiocs Diseases. 

In describing the venereal di.seases, ' page 73) we have alreadj- 
recorded their tendency to the production of sterilit\-, especially 
in the dourine of the stallion and infectious granular venereal 
disease of cattle. On page 68 we have alluded to the tendency 
of epizootic cellulitis, or pink eje, to cause sterility in the stallion. 

The Ex.\mixatiox of the Male ix relation to 
Sexual Efficiexcy. 

The ultimate test of sexual efficiency in the male is the regu- 
lar production of young. This test is not always before us nor 
is it always essential. Such conditions as abdominal crj-ptor- 
chidy, chronic orchitis with enlargement and induration of the 
testicles and numerous other conditions, require no physiologic 
test, but the anatomical conditions alone warrant a verdict of 
sterility- of an incurable kind. ^Tien he fails in the test, the 
question arises as to the cause of sterilit}-, its prognosis and 
handling. 

An animal may be highh" fertile at a given time, be fatted for 
the show ring or sale and, a few months later, may prove to be 
wholly and irrecoverably sterile. In our examination, we need 
first secure from the owner or caretaker a history- of the animal 
as a breeder, the breeding anamnesis. The veterinarian should 
determine the presence or absence of sexual desire by bringing 
the male into the presence of a strange female and obser\-ing his 
actions. A careful distinction should be made between an ab- 
sence of sexual desire and a failure of erection of the penis. 

In the presence of sexual desire, his ability to mount the fe- 
male and copulate should be tested. It should be determined 



152 Veteririary Obstetrics 

whether ejaculation occurs or not. The act of ejaculation may 
be observed bj' watching over the course of the urethra for the 
wave-like movements caused by the propulsion of the fluid 
through the channel. If ejaculation has not occurred, when the 
male dismounts, the penis is still erected, probably more than at 
the commencement of the effort. This is especially notable in 
the stallion. 

In some animals, especially the mare, a large portion of the 
semen is at once expelled from the vagina and may thus or other- 
wise be readily secured for further observation. 

The manual exploration of the sexual organs needs be careful 
and complete. The testicles should be normal in size, form, 
location and density and free from adhesions. Their surfaces 
should be smooth and even and the spermatic cords normal in 
size, soft, movable and regular. The accessory glands — vesiculae 
seminales, Cowper'sand prostate — and the vasadeferentia may be 
examined manually in the larger males and digitally in the 
smaller, and any disease or marked abnormality noted. For this 
purpose, the veterinarian in a breeding district should make him- 
self expert in the palpation of the internal genital organs by rec- 
tal exploration. The novice can draw no safe conclusions by 
rectal palpations, which acquire diagnostic value only by re- 
peated application in practice. 

The penis needs be completely exposed for proper examina- 
tion, when diseases and deformities may be readily detected. 
The urethral opening should be carefully inspected and, if neces- 
sary, explored to any desired distance with a sound or catheter. 

The quantity and quality of food should be carefully deter- 
mined and the amount of exercise or work permitted or enforced 
should be learned. 

Finally, much may be learned, if the animal copulates, by an 
examination of the semen. While the seminal fluid can be pre- 
served for hours and carried a long distance, it is preferable to 
examine it at the breeding place. Immediately after service by 
the male, semen should be taken from the vagina and placed in 
a watch crystal or on a slide with a cover glass and examined 
under a low power microscope. 

If this is not practicable and it is desired to make the examina- 
tion at a point distant from the breeding place, freshly ejaculated 
semen may be placed in a flask, which should be immersed in 



Sterility of the Feviale 153 

water at about 100° F. and maintained at this temperature until 
the examination can be made. This should be done with as 
little delay as practicable. 

The spermatozoa should be abundant and show ver}' vigorous 
movements. Even then, it is at times diflScult to judge exactly. 
We have examined semen from stallions of very low fertility, 
wJiich contained abundant motile spermatozoa. The low fertility 
apparently depended upon a want of vigor or virility in the sper- 
matozoa, not distinguishable under the microscope. But the 
presence of abundant living spermatozoa leads to the valuable 
conclusion that the glands are functioning and that the fertility 
may be heightened or perfected by bringing about a higher de- 
gree of bodily vigor of the male through properly regulated food, 
work and other agents and the virilit\' and fecundating power of 
the spermatozoa themselves raised therebj' to the normal. 

B. Sterility of the Female. 

The consideration of sterility in the female may be outlined as 
follows : 

I. Diseases and Defects of the Ovaries. 

1. Congenital Defects. 

2. Oophoritis. 

3. Tuberculosis. 

4. Tumors. 

5. Edema. 

6. Cystic and Fibrous Degeneration of the Ovaries. Nj'm- 
phomania. 

7. Persistence and H}'pertropli3' of the Corpus Luteum. 

8. Senile Atrophy. 

9. Debilitating Diseases, Emaciation, Overwork. 

II. Defects and Diseases of the Oviducts, Uterus, 

Vagina and Vulva. 

1. Arrests in Development. 

2. Salpingitis and Occlusion of the Oviducts. 

3. Metritis. 

4. Edema of the Uterine Walls. 

5. Tumors of the Genital Tract and of the Broad Ligaments. 



154 l^eterhiary Obstetrics 

6. Occlusion of the Os Uteri. 

7. Atouy aud Dilation of the Cervix Uteri. 

8. Loss of Cotyledons. 

9. Vaginitis. 

10. Persistent Hymen. 

IX. Vulvo- Vaginal Adhesions, and Constrictions. 

12. Horizontal Vulvar Opening. 

13. Rupture of the Perinaeura and Recto- vaginal Fistula. 

III. Impediments to Copulation and Fecundation refer- 

able TO Nervous Disorders. 

1. Excitabilitj-. 

2. Vaginismus. 

3. Violent Expulsive Efforts following Coitus. 

IV. Extreme Variations in Size of Male and Female. 

V. Infectious Diseases. 



I. DEFECTS AND DISEASES OF THE OVARIES 
I . Congenital Defects of the Ovaries. 

The fundamental basis of fertility in the female is the living, 
fertilizable ovum, which must be elaborated by the ovary, dis- 
charged therefrom, canght up by the pavillion of the oviduct, 
met and fertilized by the spermatozoa of the male and, migrating 
along the oviduct, reach the uterine cavity and establish intimate 
relations with the uterine walls, by which it may secure nourish- 
ment. 

The function of the ovary is fundamental in character, elabo- 
rating the ovum and discharging it when the ovisac ruptures. 
This completed, the direct function of the ovary ceases and its 
relation to fertilization and the maturation of the fetus is chiefly 
at an end. vStill. it exerts an influence. If the ovaries of a 
pregnant animal are removed, there is a definite tendency toward 
abortion and it seems that it is not the ovaries as a whole which 
exert this influence upon the fetus, but the corpus luteum, which 
remains at the seat of the ruptured ovisac, from which the im- 
pregnation has resulted. According to Hess, if the corpus 
luteum is forced from the ovary of a pregnant cow, she will 
abort. Very rarely also the fertilization of the ovum occurs 
while it is yet in the ovisac, but presumably only after its rup- 
ture, while the egg remains adherent to the walls. Eventually 
this causes the exceedingly rare phenomenon of ovarian preg- 
nancy. The completed function, therefore, of the ovary includes 
ovulation, since it is immaterial how many ova the gland con- 
tains until, by discharge, they become available for fertilization. 

The causes of nou-ovulation are numerous and maj' consist 
either in the failure of the ovaries to produce mature ova or of 
the intervention of some obstacle to the rupture of the ovisac and 
escape of the egg. 

Arrest in development or absence of the ovaries occurs with 
approximately the same frequency as the analogous condition of 
the testicles, with the exception that the female gland does not 
fail to attain functional maturity because of defective location, 
its normal adult position being within the abdomen, not widely 
separated from the point of embryonic origin. 
155 



156 Veterinary Obstetrics 

- In rare cases, the ovaries are displaced by passing beyond their 
normal adult position and, escaping through the abdominal ring, 
come to rest in the region corresponding to the scrotum of the 
male. However, this false position does not interfere with their 
function, like the abdominal retention of the testicles. 

Freemartins. In bovine twins, we meet, frequently, with an 
interruption iu the sexual development of one of the pair, which 
is generally known by the term " freemartin." The general be- 
lief among breeders is that when both twins are of the .same sex 
they are normally developed but that, when one is a male and the 
other a female, the latter undergoes an arrest in development and 
becomes a freemartin. As a matter of fact, this is not always 
true and a pair of twins representing both sexes may be com- 
plete!}' developed and capable of breeding, but very largely the 
rule holds that a freemartin is one of a pair of twins, the 
other of which is a perfect male. 

The origin of this peculiarity has not been well determined. 
While similar arrests in development are seen occasionally in all 
species of animals, whether twins or not, there is no other in- 
stance where such a condition is expected with such regularity. 
It is a quite possible that the defect is due to the fact that, in 
such cases, we have to do with homologous twins which have 
originated from the division of a single ovum, after impregnation, 
and that one of these has suffered from an arrest in sexual devel- 
ment. Whj' the other should be always, or usually, a male has 
not been discovered. 

The character of these animals is generally quite uniform In 
form, voice, behavior and other attributes they are frequently 
asexual. The head and neck partake neither of the character of 
the cow nor bull, but remind one more of an animal which has 
been castrated very young and has developed no sexual charac- 
teristics. The horns are fine, usually straight and not very 
large. The head and neck are fine. They behave and feed like 
castrated animals, and usually show no trace of sexual desire. 

Examined externally, they usually show at the ordinary loca- 
tion of the vulva a small urethral opening, having the general 
appearance of that organ, though very diminutive. 

Examined internally, the genital organs are generally found 
to have been arrested in the indifferent stage of development 
where the sexual characters are not yet far enough advanced to 



Congenital Defects of the Ovaries 157 

state whether it be male or female. The vagina and uterus may 
be somewhat developed but are ver}' rudimentary, while the es- 
sential glands may resemble more or less the testicle or the ovary 
but, as a rule, can scarcely be classified as either but simply as a 
genital gland in the indifferent state. 

Freemartins are frequently spoken of as hermaphrodites and, 
in a certain sense, they may be so regarded but, since they fre- 
quently have neither sexual desire, character, nor power, it would 
be better to speak of such as neuters. 

It is sometimes important that it be determined as early as 
possible after the birth of twin calves if one of the pair is a free- 
martin or not. At an early age the question may sometimes be 
satisfactorily answered by observing the size and form of the 
vulva, especially by comparing it with a normal calf of similar age 
and size. If the vulva is normal, it is probably a normal heifer ; 
if small, it is probably a freemartin. In a freemartin, the cavity 
of the vagina is frequently absent, which may be recognized by 
the inability to introduce a sound or a finger beyond the meatus 
urinarius. As the age of puberty approaches, the differentiation 
between heifers and freemartins becomes greatly facilitated. 
The vulva does not grow or it might better be said that a vulva 
does not exist, but rather a urethral opening in the perineal 
region, very narrow, constricted and scarcely admitting of the 
insertion of a man's finger. No clitoris is recognizable. The 
animal fails to develop sexual characters in form, voice or be- 
havior. In some cases there is present a definite vulva into 
which two, three or more fingers may be passed. Rectal explor- 
ation may reveal ovaries and uterus or cornua in varying degrees 
of perfection and estrum may occur. 

Hermaphroditism habitually leads to an arrest in the devel- 
opment of the ovary, by which it retains more or less of its fetal 
character and fails to function. 

In mules and other hybrids the ovaries fail to produce fer- 
tilizable ova as a rule, to which there are rare exceptions. In 
these animals there is usually a well marked or even exaggerated 
sexual desire, presumably due to the development of imperfect 
ova, followed by ovulation. 

Like the testicles, the ovaries are sometimes the seat of der- 
moid cysts, which may contain hair or teeth. They are neces- 
sarily congenital and may attain indefinite size. Usually involv- 



158 Veterijiaiy Obstetrics 

ing the gland to such a degree as to compromise the formation 
or persistence of normal ovarian parenchyma, ovulation from the 
affected gland does not appear and sexual desire is not induced 
bj' the presence of such glands, though, if one be normal and 
the other has undergone aberration, estrum and even fertiliza- 
tion may result from the presence of the one normal ovary. 

Calcareous degeneration of the ovaries may occur as a con- 
genital defect, the gland assuming a variable form and size and 
consisting essentially of a mass of calcareous matter devoid of 
proper ovarian tissue. The condition leads to sterility and ab- 
sence of sexual desire. 

In many cases of arrested development of the ovaries, the sex- 
ual desire and attributes are wholly absent. In most instances 
of the undeveloped ovaries, except in hybrids, the condition may 
be suspected by the diminutive size of the vulva. In cases of 
dermoid cysts and congenital calcification of the ovaries, the con- 
dition may, usually, be determined by rectal or vaginal explora- 
tion. 

This group of affections is essentially incurable, from a breed- 
ing standpoint. When the ovaries are so defective that they in- 
duce no sexual desire and cau.se no inconvenience to the patient, 
no interference is demanded. When dermoid cysts or other de- 
fects induce undesirable conditions, the removal of the involved 
gland is indicated. In all those cases where nymphomania, or 
perverted sexual desire, is present, castration is indicated. 

Oophoritis. Inflammation of the ovaries is rare in the domestic 
animals and the symptoms are, usually, not recognized during 
life. Upon post-mortem examination, it is not rare to find the 
ovaries, especially of cows, studded over with fibrous tufts, point- 
ing to an inflammatory origin, or the glands adherent to the pavi- 
lion of the oviduct. Adhesions of the ovary to the pavilion of 
the oviduct is sometimes recognizable by manual exploration per 
rectum, but the condition is not .subject to remedj^ so far as 
breeding is concerned. Such animals may be castrated and pre- 
pared for the butcher. 

3. Tuberculosis of the Ovaries is observed in cows as a cause 
of chronic oophoritis and sterility and may occur, more rarely, 
in other animals. Zschokke denies that tubercular o.varies consti- 
tute a common cause of sterility, and records that among 1 10 
sterile cows but 2 % were referable to ovarian tuberculosis. 



Tumors of the Ovaries 159 

According to this authority, ovarian tuberculosis does not, as 
a rule, cause nj^mphomania or produce other symptoms during 
life beyond sterility, which may be further identified by palpa- 
tion of the glands, when they may be found enlarged and nodu- 
lar. A further aid in diagnosis may be secured by the tuber- 
culin test. The affection is beyond remedy. 

4. Tumors of the Ovaries are somewhat rare in domestic 
animals bnt are found, occasionally, in all species. 

The}' may be malignant in character and tend to acquire large 
size before their presence is suspected or discovered. There are 
sometimes seen adenoid tumors of great size. In the museum of 
the New York State Veterinary College is an adenoid ovarian 
tumor from a sow, weighing 38 pound.s. Becoming sterile, she 
was fatted and upon slaughter the immense tumor was dis- 
covered. Cystic tumors are occasionally seen of immense size, 
especially in the mare. 

Ovarian tumors tend constantly to cause sterility with or with- 
out nymphomania. A tumor of one ovary constant!)' tends to 
inhibit ovulation from the other gland. It is usually either the 
sterility or accompanying nymphomania which attracts attention 
to the animal and leads to an examination per rectum or vagi- 
nam, which discloses the presence of the tumor. 

Tumors of the ovar)' are to be identified bj' their location, the 
absence of the normal ovaries and the presence of the tumors to 
which the corresponding uterine cornua lead and are attached. 
The ovarian tumor may contract extensive and firm adhesions 
with the walls or viscera of the abdomen or pelvis and thus com- 
plicate the question of diagnosis. Its true character is then to 
be determined b)' tracing along the uterus, cornu and oviduct to 
the ovary a'nd thus indentifying it by its relation to the uterus. 
We have observed the tumor displaced by such adhesions, so 
that it occupied a quite abnormal location. If essential to a cor- 
rect diagnosis, an exploratory incision may be made through the 
vaginal walls in the mare or cow or through the abdominal walls 
in the smaller animals. If discovered while it is of operable 
size, it should be promptly removed. When involving one 
ovary only, the successful removal of the tumor will usually re- 
store to functional activity the remaining normal gland. 



i6o Veterinary Obstetrics 

5. Edema of the Ovaries is described by Zschokke as occur- 
riug, in his experience, in old, nymphomaniac cows. The ovaries 
are somewhat enlarged and contain a few small follicles but no 
corpora lutea. Upon incision, the dropsical fluid is easily pressed 
out from the cut surface. The cut surface is grayish red in color 
and shows the usual characters of edema, which is confined to 
the gland itself. 

The abnormalitj' is to be differentiated chieflj' from cystic ova- 
ries and persistent corpora lutea. Examining the glands care- 
fully per rectum, the touch reveals the somewhat large, soft, 
yielding ovary in contrast to the firm fluctuating and sharply 
defined cysts of C3'stic degeneration or the prominently enlarged 
and comparatively firm, non-fluctuating persistent yellow body. 

The dependent sterility is usuallj- bej'ond remedy and, in case 
of nymphomania, ovariotomj' should be performed in order to 
cure the vice and permit the cow to be fatted for the butcher. 



CYSTIC AND CYSTO-FIBROUS DEGENERATION OF 
THE OVARIES OF COWS. NYMPHOMANIA' 

The most frequent and important disease of the ovaries is 
cystic degeneration, to which Zangger was the first to draw at- 
tention, in the Schweitzer Archiv. fiir Tierheilkunde, Volume 
XXII, 1859, page 280. 

It is essential to a proper comprehension of the subject that we 
have in mind a brief outline of the formation, rupture and oblit- 
eration, or astresia, of the Graafian follicles and that we recog- 
nize the significance of the formation and degeneration of the 
corpus luteum for the further deyelopment of ovisacs and the 
origin of ovarian cysts, in which we follow the highly scientific 
and meritorious investigations and contributions of our anato- 
mist. Professor Doctor Rubeli. 

It is known that the reproductive cells originate from the germinal epi- 
thelium, which sinks down into the stroma of the ovary in the form of cell 
tubes. The formation of ova in hoofed animals is generally completed at 
the time of birth. According to Bonnet, there may, in exceptional cases, 
be a possibilit}' of a new invagination of the germinal epithelium upon the 
margin of a ruptured ovisac. 

The primitive ova in the young ovary either lie somewhat scattered, as in 
ruminants and swine, or arranged in groups in the peripheral layer of the 
ovary. When the germinal epithelium has ceased its invagination, the tunica 
albuginea is formed as the outermost zone of the stroma, over which the 
ovarian epithelium extends. The primary eggs then become s -parated from 
each other b}' the ingrowth between them of the ovarian stroma, which 
pushes in between the cells and leaves each ovum surrounded by a single 
layer of smooth cells, constituting the primary follicular epithelium. Heitz 
(Archives fiir Wissensch. u. Prakt. Tierheilkunde, Vol. 32, 1906) recog- 
nizes that, in the ovaries of calves, the epithelium may- consist of a single 



^ In the following pages, ( 161-234) so far as they deal with sterility and 
nj'mphomania due to cystic or c3'sto-fibrous degeneration of the ovaries, to 
persistent corpora lu/ea, or to pj'ometra in cows, we have, with his permis- 
sion, inserted, essentiallv entire, the admirable report of Prof. Dr. E. Hess 
of the Bern veterinary school, entitled "The Sterility of Cows ", presented 
at the Annual Convention of Swiss Veterinarians at Freiburg the 19th of 
October, 1905, and appearing in the Schweizer Archiv. fiir Tierheilkunde, 
No. 6, 1906, page 351. The illustrations and some brief additions, in [ ] 
are our own. 

II l6l 



i62 Veterinary Obstetrics 

layer of endotlielium-like cells or of a concentrically arranged double layer. 
From the primary follicular epithelium there develops from the cells a cy- 
lindrical epithelium, which thus forms several layers. Regarding the origin 
of the follicular cells, opinions vary. While, in the lower vertebrates, these 
cells certainl}- originate from the germinal epithelium and this source for 
the mammalia is accepted by manj' investigators, Kolliker, Rouget and 
Biihler believe that, in the formation of the follicular epithelium, the me- 
dullar\- fibres, or genital portions of the Wolffian bodies, play an important 
part, or, indeed, in the case of the dog, cat and fo.x, constitute the exclusive 
source of these cells, Heitz observtd in the calf, in the neighborhood of 
an ovum surrounded by so-called primitive follicular epithelium, a group 
of granulation cells, which so increased at that point where the ovum was 
located that an excavation took place and, thereby, completeh- encom- 
passed it. The granulation mass either alread}- contained the ovum before 
the development of a follicular cavity or else acquired this cavity after the 
egg was completel}- surrounded. One of the foregoing conditions appears, 
from these observations, to be the ordinary course in the calf. 

As soon as the follicle has acquired a certain size, it ruptures and dis- 
charges the egg and the follicular fluid. There is still a division of opinion 
as to the cause of the rupture of the follicle. It is highly probable that 
there occurs a sudden augmentation of follicular liquid owing to vasomotor 
irritation of the nerves and, consequently, a greater pressure on the part of 
this fluid, along with .'■imultaneous thinning of the follicular walls at that 
part of the vesicle where it is to rupture. Holzl. on the other hand, com- 
pares the rupture with that of the formation of an abcess, in that, between 
the granular membrane and the theca fol ' iciili there occurs an important ac- 
cvimulatiou of migratory cells which form the so-called theca folliculi ititerua. 

Under the pressure of this infiltrated cell mass, the contents of the follicle 
are expelled in the direction of least resistance, that is, upon the external 
surface. Zschokke holds a similar view, though he does not attribute the 
rupture to the infiltration of the migratory cells, but to the multiplication 
of the cells of the theca itself at the base of the follicle. From the 
view-point of these two investigators, the thickening of the i/ieca interna 
at the base of the follicle and the thinning of the w'all upon the surface of 
the ovary has a special importance. However, it is essential to remember 
that the unequal thickness of this membrane must be referred to the con- 
dition of the blood supply since, indeed, the vessels become atrophied 
in that part of the follicle where the rupture is to occur, and, hence, the 
nutrition of this part of the theca becomes deficient. If now the mem- 
brane increases in thickness on one side and decreases on the other, so will 
the follicular contents be massed against the thin portion of the wall. The 
rupture of the follicle, consequently, does not become inevitable except 
there occurs a simultaneous increase of the intra-foUicular pressure and an 
atrophy of the wall at the most prominent point, where it is to be ruptured. 
If the latter were not the case, there would necessarily occur more or less 
hemorrhage when the follicle breaks, which, however, Zschokke himself 
denies for the cow. 

Against the Holzl-Zschokke view there is, first of all, the occurrence of 



Cystic Degeneration of the Ovaries 163 

atresia of the follicle, since, in this case, indeed, the theca interna becomes 
extraordinarily thickened yet does not lead to rupture of the follicle be- 
cause, in that case, the follicular fluid becomes decreased and the pressure, 
as a consequence, is lessened. 

Zschokke believes that a simple increase of the follicular fluid can not 
occur through hyperaemia because artificial or inflammatory hyperaemia 
does not cause ovulation ; on the contrary, it is to be observed that a local 
hyperaemia which affects the theca fotlicuti alone evidently exerts a differ- 
ent influence from an artificial or inflammatory hyperaemia which involves 
the entire ovary. It is, moreover, to be remarked that the pressure of the 
follicular fluid in follicles of different sizes is variable in degree because the 
amount of fluid evidently varies with the size of the follicle, whereas the 
intrafoUicular pressure alone can have the power to rupture the follicle. 

Zschokke believes also, a conclusion based upon personal observation! 
that ovulation often occurs in the beginning of estrum and that it is, conse- 
quently, to be held that the rupture of the follicle occurs, in some cases, 
before estrum has reached its zenith. We hold, on the one hand, from 
facts known for many decades, that ovulation, which is to be regarded as 
the manifestation of vaso-dilation, ushers in estrum ; we might however, 
on the other hand, emphasize the fact that the most evident normal clinical 
symptoms of estrum are not to be regarded as occurring at the same moment 
as the highest degree of ovarian hyperaemia. It seems to us far more 
probable that hyperaemia of the ovary precedes that of the uterus and 
vagina and that such a view is more plausible and correct. One argument 
for this view lies in the fact that, when cows, especially those in pasture, 
are bred at the beginning of estrum, they become pregnant. 

In regard to ovarian cysts, we have found small cystic follicles in ovaries 
of calves, ten to twelve days old, which were investigated by Heitz. These 
investigations showed that 80 '/r of the ovaries of cows contained cysts at 
least 3 mm. in diameter. In numerous cases, the cysts had a diameter of 
over 10 mm. and four times they reached 13 mm. Often there occurred in 
certain of these ovaries one or more cysts so greatly developed that the 
proper tissue of the ovary appeared as an unimportant appendix. By micro- 
scopical examination these were recognizable as internal follicles. The 
granulosa exhibited no marked changes, whereas degenerative processes 
existed in the egg. These follicles do not rupture spontaneously, since 
nowhere could there be seen yellow bodies or other evidences, like scars or 
fibrous tufts, which indicated ruptured follicles. Many of these follicles 
retrograde, many, perhaps, become cysts, because they show absolutely no 
decrease in size, in spite of the fact that the egg has already undergone 
serious degeneration. Cysts are not infrequently observed even before the 
first pregnancy. 

Also, in new-born calves and heifers, one meets, according to Waldeyer 1 
and others, with follicles as large as peas, containing normally developed 
ova. The same is true for various other species of animals. On the 



'Waldeyer in Hertwig's Handbuch der Entwicklungsgeschichte, p. 374. 



1 64 Veterinary Obstetrics 

•whole, these are rare exceptions in other animals, while, in the calf, they 
are extraordinarily common. 

It is readily understood that the prematurely appearing follicles do not 
rupture, for there is wanting, at this time, the h3'peraemia of estrum, 
through which, after the advent of puberty, the intrafoUicular pressure in 
adults becomes increased. 

Heitz could further determine that all follicles existing in calf ovaries had 
emanated from simple primordial follicles and had no relation to sheath 
follicles or ovarial adenoma. 

According to Simon ' the large, distended, degenerated granular cells 
appearing so numerously, lying in the inner zone against the inner walls of 
the cyst, play an important role in the genesis of these cystic follicles. 

The most convincing argument of all would be the recognition of an ovum 
in such cysts. This evidence it has thus far been impossible for us to 
adduce, since the cysts, in the preparation of the material, were incised or 
ruptvared, permitting most of the contents to escape. Zschokke has searched 
many cysts for ova but was unable, in a single case, to detect any. Accord- 
ing to this author, it is well nigh impossible to secure the entire follicular 
contents and adequately search them microscopically. The exact contents 
of these follicles in the cow need be fully determined. 

I believe it is possible to explain the cause of the existence of cysts directly 
by the structure of their walls, without taking into consideration the forma- 
tion or nonformation of the corpora lutea, which view, however, as is made 
clear by the preceding quotations, is by no means established in a manner 
free from objection. 

If we studjr the delicate tissues whicli make up the Graafian follicles of 
the ovary, we are at once impressed with the thought that the least general 
or local pathologic changes must serve to interfere with the nutritive pro- 
cesses in them. 

If the contents of such a follicle perish as a result of these changes, the 
theca, which no longer receive adequate nutrition, cannot fill the cavity 
and thus obliterate the existing defect. This may be seen in follicular 
atresia, in which a fine-meshed connective tissue network grows out into 
the follicular cavity from the theca interna. Through transudation from the 
few existing vsesels, the liquor folliculi becomes increased and the follicular 
capsule then surrounds a cavity filled with a fluid poor in cell contents. 

Contemporary with the destruction of the follicular contents, there occur 
changes in the follicular wall. It becomes markedly poor in cells and ves- 
sels. The previously round cells assume a polygonal form and show polar 
outgrowths, which establish connections with neighboring cells. There are 
now observed, in relatively large numbers, round cells appearing scatter- 
ingly amongst the polygonal ones. The inter-cellular substance, at first 
fibrous, becomes more homogeneous in the outermost zone, which is al- 
most wholly devoid of cells, and stains intensively with eosin. The vessels 



'A. Simon, Anatomisch-histologische Untersuchungen der Ovarien von 95 
Kastrirten Kiihen, Berner Inaugural-Dissertation, 1904. 



Cystic Degeiieration of the Ovaries 165 

ultimately atrophy cotnpletely, except upon the margin of the external zone, 
where there are still seen a few vessels. 

It is precisely this non-vascularity which is generally typical of the cyst 
walls investigated by us and, according to our view, constitutes the best in- 
dication for the explanation of the development of cysts from Graafian fol- 
licles. 

After the follicle has ruptured there occurs, in its place, the residual body, 
corpus luteum. It is a more or less spheroidal body, attaining a variable 
size, according to whether impregnation has occurred or not. In the first in- 
stance, it becomes extraordinarily large. It may exceed by several times the 
volume of the gland itself and persists throughout the period of pregnancy, 
to disappear only after birth. We have in this instance to deal with the cor- 
pus luteum vera, or the j-ellow body of pregnancy. In the latter instance, it 
remains smaller and disappears a few weeks later ; here we have to do with 
a corptis lutea spurium, or the yellow body of estrum. 

Among the alleged causes of the formation of these larger corpora lutea 
and their longer duration, are increased or decreased blood supply to the 
ovary during the period of pregnancy. Schulin sees the cause for the 
greater growth of the true corpus luteum in the decreased supply of nutri- 
ment to the ovary. In this connection, from observations made in path- 
ology, he emphasizes the fact that soft granulation masses persist, not in 
vigorous, but only in feeble, sickly men. Bonnet states explicitly that the 
disappearance of the yellow body is delayed because the ovary becomes 
anaemic owing to the fact that, during pregnancy, the hyperaemia of estrum 
becomes stable in the uterus, vagina, etc., as he has been able repeatedly 
to demonstrate to his personal satisfaction. Holzl takes directly the oppo- 
site view. According to him, the ovaries should receive a larger amount of 
nutrition during pregnancy owing to the increased flow of blood to the 
genitals. He believes that, during pregnancy, the ovaries hypertrophy, 
whereas a badly nourished organ does not. According to his view, the true 
corpus luteum persists for a longer period because, during pregnancy, there 
is a regular diapedesis and hemorrhage into the yellow body so that one 
finds, in gravid animals and those in the puerperal state, yellow bodies, 
which are greatly enlarged as a consequence of hemorrhages into them and 
have in their center a well-defined blood clot, completely enclosed. Similar 
observations have not yet been made in the cow since, in this animal, 
hemorrhage into the follicular cavities is unimportant or wholly absent. 
Hence the alleged causes for the longer continuation of the yellow bodies 
which have been observed in woman are not present in cattle. 

The corpus luteum consists of a brownish-yellow or ochre-yellow capsular 
layer, which contains lutein cells, and a soft, gray, transparent nucleus, 
which consists of newly formed connective tissue containing few cells and 
supplied with blood vessels ; sometimes there exists blood debris derived 
from cells which have undergone disintegration or fatty degeneration, per- 
haps mixed with cells, connective tissue fibres, etc. As the yellow body 
undergoes retrograde changes, there develops a form of connective tissue, 
which contracts to constitute the corpus fibrosum albicans. The remnant 
then represents merely the contracted nucleus of the yellow body, corpus 



1 66 Veterinary Obstetrics 

fibrosuni simplex ; or it may contain a large amount of blood pigment, 
corpus nigrum. 

Regarding the formation of the yellow body, there is still much difference 
of opinion. According to Bischoff, Schron, Pfluger and others, this struc- 
ture emanates from the membrana granulosa; von Baer, Kolliker, His, 
Spiegelberg, Paladino and others consider that it is formed from the tunica 
interna folliculi. Large spheroidal, polygonal lutein cells occur wiihin the 
fine fibrous connective tissue stroma of the yellow capsule wall and contain 
large spherical nuclei, nucleoli, nuclear debris and a finely granular pig- 
ment (lutein lipochrome) permeating the protoplasm. According to Sabotta, 
in the mouse and rabbit, and to van Beneden and Honor^, in rabbits, these 
certainly arise from the membrana granulosa. The same origin holds good, 
according to Giacomini, and also Mingazzini, for reptiles and birds. Van 
der Stricht saw these cells derived, in part, at least, from the granulosa in 
vesperugo noctula. . On the other hand, Clark, Nagel, Biihler and Stokel 
are of the opinion that the lutein cells are derived from the cells of the 
tunica interna folliculi. Zschokke speaks in much the same waj' of the 
origin of the yellow body in cattle. He says, " I have for a long time thor- 
oughly studied and sectioned dozens of ovaries of various animals and am 
fully convinced that they are derived from the tunica interna." He found 
a distinction in the nuclear staining of the granulosa cells and those of the 
tunica ; the first vvas more intense. He further observed that the debris of 
the granulosa could b; differentiated by their form from the growths ema- 
nating from the tunica interna. It is impossible, however, for one to deter- 
mine these differences in the illustrations in Zschokke's work and to 
recognize which tissue one is observing because the magnification is too 
feeble. 

The destiny of the yellow bodies is chiefly that thej' shall occupy the 
cavity which occurs as a result of the rupture of the follicles. 

According to Bohn, who agrees with Frankel and Cohn, the yellow body 
consists of a substance secreted by the system, being derived from the blood 
through the influence of the attachment of the egg to the uterus. 
Closely allied to this, also, is the view that the yellow bodies, through 
these secretions, exert a restraining influence in a certain way upon 
the ovary and the further development of follicles. In relation to the latter 
point, perhaps, the simple pressure of the yellow body upon the ovary is 
partly responsible for the result. Zschokke asserts that, where large cor- 
pora lutea exist, as a general rule, large, ripe follicles are wanting, while, at 
the same time, in these animals, estrum is usually absent. Other veteri_ 
narianshave, on the olher hand, observed that the existence of yellow bodies 
does not alwa3's prevent the occurrence of estrum. 

In reference to the number of ovarian cysts occurring in one 
animal, we have found in ovaries secured by castration or after 
slaughter that one gland may be normal while the other has un- 
dergone cystic degeneration in an extremely variable degree. Very 
frequently both ovaries suffer, sometimes equally, but far more 



Cystic Degeneration of the Ovaries 



167 



commonly in a different degree. Not infrequently one observes in 
an ovary, both superficially and deeply, one to four cysts ; in other 
cases, one large cyst. Ovaries containing two to three large and 
two to four small cysts are by no means rare. While, under 
normal conditions, the ovary of the cow varies in size between a 
bean and a large hazelnut, the gland which is affected with cystic 
degeneration shows, upon its nodular surface, varying numbers 
of stellate, radiating or linear scars. The special position of the 
cysts, which always develop from the follicles, is the stratum par- 
enchymatosum and especially the stratum vascidosum. In the 
former, the location of the cyst is more superficial or peripheral, 
while, in the latter, it is central, The cysts, usually with smooth 
walls, are found located, as a rule, at the inferior or superior 
pole of the ovary or occur simultaneously in both positions, and, 
generally 3 mm. from the mesovarian or ligamentous border and 
i-io mm. from the free border. Cysts also occur imediately upon 
the free border, especially in the middle of the organ. It is, 
moreover, quite common to find in the center of the ovary, one 




Fig. 16. Normal and Cystic Ovaries of Cow. 

A, B, B', Cystic ovaries. 

B', Section of B, showing it to consist of two large cysts and one 

corpus luteum with no visible ovarian tissue. 
C, Section of the normal ovary, D, showing ovisacs and one corpus 

luteum. One-half size. 



1 68 Veterinary Obstetrics 

to four follicles of the size of a pea or small hazlenut. These do 
not project beyond the surface of the gland, but occupy the place 
of the vascular stratum, around which the external part of the 
ovary continues to form a tissue capsule 3-8 mm. in diameter. 
In isolated instances, also, the ovary may undergo atrophy because 
of the formation of abnormal follicles, until it becomes merely a 
remnant, in which only a few small follicles can be distinguished. 
Many times, in the sound portion of the surface of the ovary, 
there are observed numerous follicles. 

In regard to the extremely variable thickness of the walli of 
peripheral cysts, it is to be emphasized that, in many cases, their 
walls are as thin as paper, consisting of a very delicate cuticle, 
which is easily ruptured upon pressure ; in other cases, on the 
contrary, there is a thickness of 6-8 mm., which explains the 
fact that spontaneous rupture of the cyst may occur or that a 
variable degree of force may be necessary in order to crush it. 

Analogous to the variations in the strength of the exterior 
walls, there are also differences in the thickness of the sheath 
walls of the ovarian tissue of the cyst in one and the same ovary, 
ranging from 1-8 mm. 

According to the anatomo-histologic investigations of Simon, 
already quoted, under the direction of our esteemed colleague, 
Rubeli, in the Veterinary Anatomy Institute of this college, the 
average volume and weight of the ovaries of 95 castrated cows 

was as follows : 

Right Ovary. Left Ovary. 

Maximum weight. 25.4 gr 20.3 gr. 

Medium weight 14-33 gr lo.ii gr. 

Minimum weight. 6.8 gr. 5.2 gr. 

Maximum length 7.0 cm 5.1 cm. 

Medium length 4.3 cm 3.71 cm. 

Minimum length i.o cm 2.1 cm. 

Maximum width 4.0 cm 3.8 cm. 

Medium width 2.8 cm. 2.36 cm. 

Minimum width 1.7 cm i.6 cm. 

Maximum thickness 3.9 cm. 3.9 cm. 

Medium thickness 2.53cm 2.15 cm. 

Minimum thickness 1.3 cm 1.3 cm. 

According to these tables the right ovaries are, on the aver- 
age, greater than the left, both in weight and volume, a fact 
which, concerning the size, can be readily determined by rectal 



Cystic Degeneratio7i of the Ovaries 169 

exploration. This indicates a probable greater functional ac- 
tivity of the right organ. 

According to Zschokke, the ovaries of medium sized animals 
weigh approximately 14-19 gr. The dimensions of the ovaries 
of healthy cows vary between 42 and 47 mm. in their greater, or 
longitudinal axes, and 12-15 ™ni. in their transverse diame- 
ters ; in heifers they are approximately 23-27 mm. and in aged 
cows 31-36 mm. 

It is to be observed that the weight and size of the ovaries is, 
in a large measure, dependent upon prior physiologic occur- 
rences, such as estrum, conception, etc. 

There is frequently observed upon the surface of the ovary 
linear or stellate scars, the most prominent linear scars of which 
we attribute to the rupture of cysts because these occur especially 
in those ovaries in which we have crushed various cysts. The 
stellate scars are referred by Zschokke and Simon to the rupture 
of follicles in which the corpus luteum does not, as is the case in 
most instances, project beyond the surface. 

Aside from these cicatrices, there is often found upon the sur- 
faces of many ovaries fibrous tufts as much as 1.6 mm. long 
which possess no clinical importance, and which, according to 
Simon, consist of numerous capillaries and embryonal wavy, 
connective tissue fibres with a few small spindle cells and elastic 
fibres and often arise from the margins of old yellow bodies. 

We have personally found that in cases of cysto-fibrous de- 
generated ovaries, which had been vigorously crushed two or 
three times within a few weeks in consequence of cystic degen- 
eration in the deeper parts of the organ, not only an evident 
enlargement of the gland, but that, after castration or slaughter, 
there was present on the surface of such ovaries a great number 
of intensely red, fresh, thick tufts, partly in sheet-like groups, 
partly as solitary projections. 

ETIOLOGY. 

According to the teachings of our extensive statistics, here 
omitted in order to save space, cystic degeneration occurs most 
frequently in highly bred, early maturing valuable breeding and 
milch cows of from five to eight years of age and in well kept 
heifers of i^ to 3 years. However, ovarian cysts, in young 
calves and in aged animals, are not at all rare. We have also 



lyo Veterinary Obstetrics 

observed ovarian cysts in mares, sheep, goats and swine, always 
in the latter animals without njmiphomaniac symptoms, (vid. 
Post Mortem Findings 7 and 8), [We have operated for nympho- 
mania due to ovarian cysts in the bitch.] 

In regions with very iatensively forced cattle-breeding and 
dairying, upon estates where large quantities of artificial ferti- 
lizers are used, artificial foods are employed, and where pedi- 
greed breeding animals are overfed, especially on rye, distiller's 
grains, malt and, in addition, are constantly stabled, the disease 
is indigenous, while, in animals more naturally and moderately 
fed and kept much at pasture, the disease is far more rare. 

Aside from the fact that nymphomania is especially common 
in highly fed, stabled cows and in certain establishments it is 
also apparent that there is a casual connection in the frequency 
of its appearance according to the character of the season, the 
change from grass to hay feeding and in connection with 
parturition. 

On the other hand, there is not sufficient evidence to warrant 
the conclusion that ovarian cysts are directly inherited, although, 
in some cases found among cows of the same family. Neverthe- 
less, we believe that the disposition to the formation of cysts is 
hereditary and that this tendency becomes emphasized through 
intensive feeding, constant stabling, deep milking, frequent 
breeding and through attacks of the nodular venereal disease. 
The tendency to cystic degeneration may also be favored by all 
conditions by which certain uses, like milking or breeding, be- 
come hereditarily emphasized, or the vital energy is greatly 
depressed, that is, a predi.sposition is established for diseases of 
the milk glands, ovaries and uterus. 

The primary causes of the formation of cysts are, as yet, un- 
known. Among other causes which have been suggested, we 
may mention that proposed by Giovanoli,' who believes that it 
may be due to cerebral disease. According to the investigations 
of Simon, the occurrence of ovarian cysts cannot be referred to a 
chronic oophoritis with secondary thickening of the albuginea 
because he failed to find in any such ovaries a thickening of this 
tunic, although they were generallj' cystic in a high degree. 



' Giovauoli. Schweizer-Archiv. fur Tierheilkunde, 1S97, page 77. 



Cystic Degeneration of the Ovaries 171 

In how far the frequentlj' occurring ovarian cysts in new born 
calves and the presence, in ovarian follicles, of the coccidiinn ovi- 
formcB, first recognized by Professors Rubeli and Guillebeau and 
Dr. Simon, exert an influence upon the cystic degeneration of 
the ovary, requires further investigation. 

A disease which, according to our view, certainly possesses 
great etiologic importance is the granular venereal disease {va- 
ginitis et metritis follicidaris infectuosa') because the relative fre- 
quency of diseases of the ovary and uterus is much greater after 
the appearance of that plague than before ; likewise, one finds, in 
cows and heifers affected with diseases of the ovaries, extraordi- 
narily severe symptoms of vaginitis et metritis follicnlaris 
infect7iosa. 

In one case we observed primarily, in a cow, a prolapse of the 
vaginal portion of the uterus and, four weeks later, a large cyst 
in each of the ovaries. 

Undoubtedly, also, the normal occurrence of birth and unilat- 
eral castration exerts an important influence upon the formation 
of ovarian cysts. 

It is highly interesting to note that the data drawn from over 
200 nymphomaniac animals observed by us during the year 1905, 
among which were three heifers, show that 92% were affected 
with cystic ovaries and, among these, were found 4 head which 
had aborted and later suffered from retention of the placenta, 
while all the others, aside from the 3 heifers, had completed the 
normal duration of pregnancy. 

Of the 92 % above mentioned, 5 cows had suffered from de- 
layed expulsion of the after birth and secondary septic endome- 
tritis, 4 from torsion of the gravid uterus and 7 from parturient 
paresis. So far as we could determine, these cows, which later 
became nymphomaniac had given birth to approximately the 
same number of male and female young. 

It is worthy of record, also, that, in one case, there was found 
a follicle as large as a hazelnut in the left ovary of a cow which 
had been slaughtered during the sixth month of pregnancy be- 
cau.se of agalactia, she being fat. 

Symptoms. 

For decades past, the symptoms induced by ovarian cysts have 
been designated by the terms bulling or nympho^nania . In the 



ryz Veterinary Obstetrics 

latter term, we recognize a true or erethetic nymphomania and 
the so-called dumb estrum (stillochsigkeit ), in which latter, re- 
gardless of the existence of the sinking of the great sciatic liga- 
ments, symptoms of estrum are either entirel}' wanting or are 
only of a very feeble character. 

A. Nymphomania. 

General Symptoms. 

Under normal conditions in non-preguant cows, estrum occurs 
every three weeks and, if the milk secretion is not too intense, it 
begins from 6-8 ^^€&s, post partum. Vascillations of the estrual 
periods between 21-28 days must still be regarded as normal, 
while less than 21 or more than 28 days, as for example, estrual 
periods of 6-9 weeks, according to our statistical observations ex- 
tending over several years, can no longer be viewed as normal 
because experience teaches that animals with reduced or pro- 
longed estrual periods either fail to conceive, or do so only with 
difficulty. On the whole, we have observed that the normal 
duration of estrum in the cow is 15-24 hours and that its pro- 
longation to 30-^6-48 hours, progres-sively diminishes the proba- 
bility of conception. 

The probability of conception is also decreased if the duration 
of estrum is very brief or if it is excessively intense or goes to 
the opposite extreme and is very weak, as well as when there is 
a marked or abundant sanguineo-mucous vaginal discharge after 
the cessation of estrum. Only in exceptional cases have we ob- 
served conception to occur at the first service in well nourished 
cows, which, at times, remain in vigorous heat for fully 48 hours. 

All the varied deviations from the above described normal 
estrum fall within the designation of " bulling " or of "dumb 
estrum" and especially do we designate as nymphomania those 
cases in which the estrum is excessive and irregular or is of too 
permanent a character. 

In reference to the relation between estrum appearing at the 
normal period, the anatomical character of the ovaries and the 
sinking of the broad ligaments of the pelvis, we may relate the 
following details in cases presenting the common characteristic 
that they fail to conceive. 

Quite exceptionally we met with cystic degeneration of the 



Nymphomania 173 

ovaries in cows which were in estriim regularly every 21 days 
and showed constant slight sinking of the broad pelvic ligaments. 
In one instance we recognized a small cyst in the right ovary 
and a large one in the left, in one case a cysto-fibrous degenera- 
tion of the left ovary, in another animal endometritis catarrhalis 
chronica, and in a third, an endometritis piirulerita chronica. 

The usual case of nymphomania runs a chronic course without 
fever and shows, among its complex symptoms, many variations. 
Often one scarcely notes any disturbance of the general health ; 
in other cases, it is clearly linked with nervous symptoms. The 
pulse varies between 60-66 per minute, the respirations from 12- 
24. The state of nutrition varies widely according to the age, 
environment, feeding of the animal, and the duration of the 
malady. While nymphomaniac heifers and young cows which 
are handled early are generally in a good state of nutrition with 
glossy coat and soft skin, in aged breeding and milch cows the 
condition is only moderate or even bad. The live weight of large 
nymphomaniac Simmenthaler cows, according to our records, 
varies between 400-800 Kg. (i Kg. = 2.2 lbs. ) 

Among the earliest symptoms of nymphomania, is the failure 
of the milk yield to increase during the few days following par- 
turition and the so-called "hidebound" condition of the ani- 
mal, which maintains well nigh constant connection with the for- 
mation of ovarian cysts in conjunction with slight endometritis 
catarrhalis acuta and more rarely rests exclusively and wholly 
upon endometritis catarrhalis acuta and is characterized by a vi- 
cious and restless behavior of the cow, nervous movements, with 
glassy eyes, the eyelids opened wide, the animal easil}' terrified, 
staring, wild, vicious expres.sion and dry hair. Sooner or later 
there appears, also, a loss of appetite and condition and decreased 
lactation. The animal feeds more and more erratically, becomes 
agitated without visible cause, the agitation not unfrequentlj? 
amounting to a veritable storm, accompanied with pawing, low- 
ing and bellowing (bellowing disease.) 

Should the latter symptoms develop during the night, other 
cattle in the same stall are made to suffer and even the people of 
the house may be disturbed. In some cases the diseased animal 
may escape from its fastenings, and opportunity be given for the 
fracture of the external angle of the ilium, the pelvis, etc. Hand 
in hand with these symptoms goes sexual excitement of great 



174 Veterinary Obstetrics 

intensity but not identical with normal estrum ; sometimes it 
follows a very slight estrum, in other cases it is brought to light 
only when a cow standing beside the diseased one comes into 
heat and very often is first observed when the animal is out at 
pasture. Sexually excited cows seldom lie down and only for 
brief periods. They assume an aggressive behavior, attempt to 
rub their posterior parts upon other cows or objects, elevate the 
tail, urinate frequently, less frequently exhibit vaginal straining 
and neither drink deliberately nor even graze quietly. In the 
pasture these animals graze badly, run about, annoy the herd, 
and tear up the earth with horns or hoofs. If the nymphomania 
is intensely developed the animal becomes very vicious toward 
surrounding objects, especially strange persons or glistening 
bodies in bright colors and falls upon them, as we have repeatedly 
observed, in maniacal fury. In some cases of nymphomania, the 
affected animals attempt to mount neighboring cows, bulls, oxen, 
and even persons and continue to ride the former for a long in- 
terval ; on the other hand, they permit bulls and also other cows 
to mount them constantl}\ [The viciousness of nymphomaniac 
cows and their tendency to mount persons when not on their 
guard make such animals a positive menace to keepers or others 
who come in contact with them, as we have had occasion to per- 
sonally observe. In one instance observed by us, a previously 
kind cow became dangerousl}' vicious toward women and would 
attack them furiously at every opportunity.] 

There occur nymphomaniac cows with cystic ovaries, however, 
which, on the contrary, resist all attempts of bulls or of other 
cattle to mount them. After a variable duration of the malady 
the affected cow, which has already become markedly unthrifty, 
shows an elevated croup, a forward sinking of the anus and vulva, 
lordosis, stiffness of the loins, associated with an upright direc- 
tion or knuckling-over of the hind fetlock, ' ' kuhhessige ' ' posi- 
tion and often a slightl)' staggering gait. That a nymphomaniac 
cow may suffer simultaneously from other diseases, such as capped 
knee, pelvic fractures, foul in the foot, etc., is to be regarded 
merelj' as a coincidence and that old, oft recurring cyst forma- 
tion may lead to an exaggeration of all the symptoms described 
is readily understood. 

According to the duration of time between the last parturition 
and the advent of the njmiphomania, there is a somewhat corre- 



Nymphonian ia 175 

sponding variation in the character of the udder and milk. In 
most of the cases observed by us, the udders were large and finelj' 
developed and j'ielded, before the advent of nymphomania, 8-12 
liters of milk per milking and only in a dozen cows were we able, 
in the year of 1905, to recognize a small and flaccid udder and in 
but a single animal a fleshy udder and, in harmony therewith, a 
yield of but 2^ to 6 liters of milk .per milking. 

In nymphomaniac cows which had been in milk for a long 
period the milk from one or more of the quarters was, in some 
cases, white and without coagula but usually somewhat alkaline 
or bitter. Occasionally there was a " holding up of the milk " 
during one milking, a phenomenon which we attribute to vaso- 
motor paralysis and debility of the vascular muscles of the teats. 

Special Symptoms. 

Among the special apparent symptoms of ovarial nymphoma- 
nia, sinking of the broad ligaments of the pelvis takes the first 
place. Although not pathognomonic, it is constant. This S3'mp- 
tom may reveal itself in varying degree and it is necessar}' for its 
proper observance that the animal be stood in a normal position 
on even ground. 

Concerning the relaxation of the great sciatic ligaments, 
Goubaux first suggested that it was the result of a serous infil- 
tration of these structures, leading to their elongation and de- 
creased tension. In a similar manner Franck expressed the 
opinion that, in addition to this cause, the gravid uterus exerted 
an influence by dragging the anus and vulva downward and for- 
ward, thus pulling the sacro-sciatic ligament inwards into the 
pelvic cavity. Berdez ' was the first to describe the sinking of the 
sciatic ligaments as a purely mechanical result of a flexion of the 
pelvis at the sacro-iliac articulation by which the ligaments be- 
came relaxed, permitting them to sink inwards. He constructed 
a highly ingenious model for that purpose, by which he showed 
how the weight of the gravid uterus upon the abdominal floor 
served to stretch the sacro-sciatic ligaments. Shortly prior to 
birth the uterus contracts, the load — fetus, fetal membranes and 
waters — is lifted from the abdominal floor and is largely supported 



1 Berdez, Schweitz Archiv. fiir Tierheilkunde u. Tierzucht, vol. 4, 
page 188. 



176 Veterinary Obstetrics 

by other agencies, such as the mesometrium, vagina, diaphragm 
of the pelvis, etc. The pelvic ligaments are thereby relaxed and 
sink inwards. This very simple and plausible theorj' of Berdez 
is opposed by Zschokke because, according to his investigations, 
drawing in the direction of the rectus abdominis muscle does 
not produce the effects described nor can the unilateral sinking 
frequeutlj' observed in practice be explained by that theory. What 
effect the contraction of the rectus abdominis muscle exerts is 
not stated bj' Zschokke. 

Fuhrimann ' was enabled for the first time, in our ambulatory 
clinic, to recognize that sinking of the sciatic ligaments occurs 
in various diseases of the genital organs, as well as of the milk 
glands, and is not at all confined to diseases of the ovaries. He 
was further able to induce sinking of the broad ligaments of the 
pelvis experimentally bj- inserting kelp pencils in the cervix uteri. 
From these data it follows that any sufficiently powerful irrita- 
tion in any portion of the genital tract is capable of inducing 
sinking of the broad ligaments of the pelvis. The previously 
accepted theorj- of infiltration of the ligaments must, therefore, be 
abandoned. 

The measurements taken by Fuhriman on the prepared pelvis 
have further indicated that the stretching and relaxation of the 
pelvic ligaments through flexion of the ilio-sacral articulation 
may be induced, as claimed b}' Berdez, and that these movements 
are greatly favored in the cow because of the extraordinary 
mobilit}' of the lumbo-sacral articulation, especially by the sink- 
ing of the loins. It is recognized that a mild grade of physio- 
logic sinking of the broad ligaments of the pelvis occurs often 
during normal estrum, also in a normal manner 8 to 15 days 
before calving or, under some conditions, such as high feeding 
and having to lie on sloping floors, it even occurs 4 to 6 weeks 
ante partum, and normall}' disappears inside of 8 to 12 days after 
parturition. 

In cases where the relaxed condition of the pelvic ligaments 
persisted on one or both sides throughout the entire duration of 
pregnancy and at times even embraced several consecutive preg- 



• Fuhrimann, Uber die Senkung der breiten Beckenbander beim Rinde. 
Berner Inaugural-Dissertation igo6 und Archiv. fur wissentschaftliche und 
praktische Tierheilkunde, Bd. 32, 1906. 



NympJiomania 177 

nancies, in many instances to a marked degree, we observed now 
and then — and these cases afford striking evidence — that sinking 
of the hips and pregnancy are not incompatible. We also now 
and then see the so-called false estrum, especially during the 
second half of pregnancy, probably as the result of active hy- 
peraemia of the genital canal. We have observed this false 
estrum continue throughout the period of pregnane}' and, accord- 
ing to our observations, it is very similar to the normal estrum 
of non-pregnant cows. In one cow in which there was sinking 
of the right broad pelvic ligament throughout pregnancy there 
was a constant sexual excitement, as evidenced by her mounting 
other cows. We here recognized a salpingitis of the right 
oviduct, which had not prevented conception. In another case, a 
cow five months pregnant had to be returned home from the 
mountain pasture because she constantly permitted the bulls to 
copulate with her. 

We recognize the abnormal sinking of the broad ligaments in 
the following diseased conditions : in 92 '-'/o of the cases of ovarial 
cysts as well as in advanced fibrous degeneration of the ovaries, 
in hydrops tubarum (cystic distension of oviducts) with sound 
ovaries, in acute and chronic catarrhal and purulent metritis, 
P5'ometra, prolapsus of the vaginal portion of the uterus, vaginal 
prolapse, infectious nodular metritis and vaginitis, septic me- 
tritis, tubercular metritis, severe traumatic vaginitis and coUitis, 
large retention cysts in Bartholin!' s glands, severe mastitis 40 
hours after its development, bacterial pyelo-nephritis, orchitis 
and, ill old, heavy nonpregnant cows and in one breeding bull 
from over fatigue from transportation on foot. 

We have now and then observed a slight sinking of the broad 
ligaments of the pelvis in cows which, in spite of regular estrum, 
do not conceive and in which the cervical canal remains open 
as a consequence of chronic catarrh. A similar condition is also 
seen in profuse milkers 2-3 weeks after parturition due to a gen- 
eral debility and atony of the genital organs in connection with 
insufficient uterine involution, especially a slight catarrhal 
metritis. 

In reference to the date of the advent of the sinking of the 
broad pelvic ligaments in newly calved cows, a study of those 
cases in which data upon this point have been secured and 



lyS Veterinaiy Obstetrics 

which include but a very small percentage of the total number 
of cases of nymphomania recorded by us, it appears that, in 12 
cases out of 120 observed during the first six months of 1905, a 
complete return to the normal elevation of the hips or recovery 
in tone of the broad ligaments did not occur within the normal 
period after calving but that the sciatic ligaments retained their 
relaxed condition during the first 1 2 days or increased somewhat 
after 3-7 days. In 100 cases the normal tension of the broad 
ligaments was reestablished within 12 daj's after calving which, 
however, after the following periods of time, again became re- 
laxed, namely : 

In 2 cases inside of 16 days post partuni 

"7 " " 3 weeks " " 

"4 " - " 4 " 

" 6 " ■' 5 "' " 

" 5 " "6 " 

" 5 " "7 " 

"14 " " 2 months " " 

" 12 " " 3 " " " 

"10 " " 4 " " " 

" 7 " "5 " 

" 9 " "6 " 

" 3 " "7 " 



According to these exhibits, the relaxation of the broad liga- 
ments of the pelvis occurred during the period of most intense 
lactation, the first 4 months after calving furnishing 77 cases, as 
against 35 cases at a later date, or about 2:1. 

In regard to the relation between the sinking of the broad lig- 
aments and nymphomania, the 1 20 cases cited above furnish the 
following clinical data : 

The 120 cases of nymphomania showed in 112 cases a sinking 
of the broad ligaments, and in 8 cases no sinking. 

Of the 112 cases, the sinking of the sciatic ligaments was as- 
sociated : 

8 times with regularly recurring estrum every three months, 
which was very intense and was prolonged for 3-4 days ; 



Nymphomania 179 

14 times with irregular estrum ; 

59 times with nymphomania. 

In 31 cases estrum failed to occur at all, or occurred but 
rarely and was very slight. 

In 13 cases the sinking of the ligaments was slight. 

In 36 " " " " " moderate. 

In 63 " " " " " severe. 

The 8 cases of nymphomania, without sinking of the ligaments, 
occurred wholl)' in vigorous cows, in high condition, partly in 
animals yielding a heavy flow of milk. The group included 4 
cows vidth bilateral ovarian cysts as large as hazelnuts ; one cow 
which showed irregular estrum and, in addition to a cyst as large 
as hickory nut in the right ovary, exhibited a chronic catarrhal 
metritis; another cow which had a cyst as large as a hen's egg 
and a corpus leictum in the right ovary ; another showing in the 
right ovary, a cyst of the size of a hen's egg, in the left a small 
yellow body, and, in addition to these, a slight catarrhal endome- 
tritis, and in the last cow we found in the right ovary a cyst as 
large as a hickory nut. 

The failure of the ligaments to sink when ovarial cysts exist 
depends, apparently, on the one hand, upon the slight individ- 
ual susceptibilit}', and on the other, upon the evidently vigorous 
constitution of the patient. 

As to the relation of the sinking of the sciatic ligaments to the 
presence of ovarial cysts, our statistics revealed the following : 

In the 112 cases of sinking of the broad ligaments it was 
found that : 

in 32 cases, there was a bilateral sinking of the broad liga- 
ments accompanied by bilateral ovarian cj'sts ; 

in 24 cases, the sinking was bilateral and the formation of cysts 
unilateral, in the right ovary ; 

in 10 cases, the sinking was bilateral and ovarian cj'sts occurred 
only in the left ovar}' ; 

in 4 cases the sinking and ovarian cysts were alike found on 
the right side only ; 

in 3 cases the sinking and cysts were found on the left side 
only ; 

in I case the sinking was bilateral, the right ovary cystic, the 
left had undergone fibroid degeneration ; 



i8o Veterinary Obstetrics 

in 2 cases the sinking was bilateral and onl}^ the left ovary had 
undergone fibrous degeneration ; 

in I case the sinking was bilateral, the right ovary showed 
fibrous degeneration and the left was cystic ; 

in I case the sinking was bilateral, while only the right ovarj' 
showed fibrous degeneration ; 

in 2 cases the sinking was bilateral ; the right ovary contained 
2 yellow bodies and the left, one cyst ; 

in 7 cases the sinking was bilateral and both ovaries had un- 
dergone fibrous degeneration ; 

in I case the sinking was bilateral ; the right ovary appeared 
normal, and the left contained a cyst as well as 2 yellow bodies ; 

in I case the sinking was bilateral ; the right ovary had un- 
dergone cystic and fibrous, and the left, fibrous degeneration ; 

in 3 cases the sinking and cj'stic degeneration were bilateral 
and accompanied by prolapsus vagimz ; 

in 4 cases the sinking was bilateral while the cj^stic degenera- 
tion, accompanied b}' prolapsics vaginee, affected the right ovary 
only ; 

in 3 cases the sinking was bilateral, while the cystic degenera- 
tion, accompanied bj^ prolapsus vaginee, involved the left ovar}' 
onh? ; 

in I case the sinking was bilateral and the ovaries normal, but 
prolapsus vagi7i<z existed ; 

in I case there was bilateral sinking ; the right ovary was 
tuberculous, the left cystic ; 

in I case the sinking was extreme, with bilateral cystic de- 
generation, to which was added fibrous degeneration of the right 
ovary ; 

in I case the sinking was severe and bilateral ; the right ovary 
was cysto-fibrous degenerated ; the left onl}^ C3'stic ; 

in I case the sinking was severe and bilateral ; the left ovar}' 
was cystic ; the right ovary contained a greatly hypertrophied 
yellow body ; 

in I case the sinking was bilateral ; there was revealed a cyst 
and a yellow body on the right, and a cyst on the left ; 

in I case the sinking was bilateral ; the right ovary contained 
a cyst, while in the left there was a yellow body the size of a 
hickory nut ; 



Nymphomania i8l 

ia I case the sinking was bilateral ; the right ovary contained 
2 large cysts, the left was normal ; 

in £ case the sinking was bilateral ; the right ovary contained 
a cyst the size of a hen's egg, the left was normal ; 

in I case the sinking was bilateral ; the right ovarj' normal ; 
the left contained a yellow body as large as a man's thumb and 
to this was added the complication of a chronic purulent metritis ; 

in I case the sinking was bilateral and also there was 
present cystic and fibrous degeneration of both ovaries and 
prolapsus vagina \ 

in I case the sinking was bilateral ; the right ovar}-, of the size 
of a hickory nut, was cystic and had undergone fibrous degenera- 
tion ; the left contained a hypertrophied yellow body ; the os 
uteri was open and chronic purulent endometritis present ; 

in I case the sinking was bilateral ; the right ovary contained 
a cyst the size of a goose egg ; the left was normal. 

This tabulated summarj' indicates that sinking of the hips 
generally indicates some affection of the sexual organs, especially 
of the ovaries, and that a good, firm tension of the broad liga- 
ments of the pelvis constitutes excellent evidence of sexual sound- 
ness in the cow because, between the character of the tension of 
these sciatic ligaments and the specific sexual organs, there exists 
a relationship quite analogous to that in man between the pos- 
terior portion of the eye and cerebral disease. 

It further appears that the relaxation of the sciatic ligaments 
does not always indicate bilateral cystic degeneration of the ova- 
ries, that in individual cases it may occur in the absence of cystic 
degeneration and that the right ovary was found cystic twice as 
frequently as the left. 

In general, we have determined that, when the relaxation of the 
sciatic ligaments is unequal, the ovary on the side of the greatest 
relaxation is the one which has, most probably, undergone cystic 
degeneration. On the other hand, now and then, the broad 
ligament is appreciably more relaxed on the side of the sound 
ovary than upon that of the cj'stic gland and, in the bilateral 
formation of the cysts in the periphery of the glands, the 
greater sinking tends to occur on that side where the cyst or 
cysts is the larger, firmer and older. Also, in unilateral sink- 
ing of the sciatic ligaments, cystic degeneration va&y likewise be 
unilateral and involve only that ovary on the side corresponding 



1 82 Veterinary Obstetrics 

to the relaxed ligament, and this presumption is not changed 
b}' the presence of fibrous degeneration in the other gland. 
Finall}', in fibrous degeneration of the ovaries, the sinking 
of the hips is only slight or moderate, never severe. 

In one nj'mphomaniac cow, the right sciatic ligament was 
slightlj' sunken ; the left one, verj^ markedly'. The right ovary 
showed a cyst the size of a hen's egg, with slight increase in cir- 
cumference of the right uterine cornu ; the left ovary was of the 
size of a hazel nut and the left cornu the thickness of a man's 
arm. 

The question if, probably, the size and age of the cysts exert a 
definite influence upon the degree of the uni- or bilateral sinking 
of the broad ligaments must be answered in the negative. Our 
obser\rations teach that small, and especially the very small cysts 
in heifers, often cause a very marked sinking of the ligaments, 
and vice versa; furthermore, now and then, the sinking on the 
side corresponding to the smaller cyst is materially greater, 
and in cases of cysts varying greatly in size in the two 
ovaries, the sinking in of the hips may yet be alike on both sides. 

From the standpoint of age, it seems clear, from our observa- 
tions, that cows with old and large cysts, because of the chronic 
reflex irritation upon the sexual organs, through which the re- 
laxation of the broad ligaments is caused, generall}' show also a 
greater degree of sinking than those with newly formed cysts. 

When the sinking of the broad ligaments does not occur im- 
mediatel}' after calving, the anamnesis usually indicates that the 
affected animal had already been in estrum several times at too 
short intervals and too intense in character or continued for an 
abnormalh^ long period, without conception occurring. 

The degree of the sinking of the hips, which is sometimes more 
marked at the the posterior border, and sometimes upon the flat 
surface of the hips, but is usually equally evident in both areas, 
is, as already stated, extremely variable. The sinking is 
very greatl}' emphasized by a high croup, which has no real 
influence upon the sinking of the ligaments and has, under 
normal conditions, merely the value of a blemish. In exag- 
gerated cases, the sunken broad ligaments of the pelvis con- 
stitute an almost flat surface beneath the tail and, at the sides 
of the root of the tail, cause cavities the size of a fist. 



Nymphomajiia 183 

Out of the 120 nj'mphomaniac cows of our statistics, 47 ex- 
hibited more or less evident changes in the vulva, consisting of 
an edematous swelling of variable intensity, exceptionally greater 
on one side, and an elongation and widening of the vulvar com- 
missure. In 12 cases there was a slight active hyperaemia evi- 
denced by a redness of the labiae of the vulva, referable to a 
pressure upon the vasodilators in the ovaries. In a few cases, where 
prolapse of the vagina coexisted, there was an evident wrinkling, 
either chieflj^ in the superior half or involving the entire circum- 
ference of the vulvar lips, as well as invagination, that is, an 
entropium of the vulvar lips. 

It is of symptomatic significance that, in heifers suffering from 
dumb estrum (stillochsigkeit ), the variable edematous swelling 
of the vulva, under some conditions, constitutes the only notable 
external symptom which, omitting the abnormal findings in the 
ovaries, can not at all be explained. 

Among our 120 cases there existed in 42 a very variable vaginal 
discharge. In 30 cases, this was slight, vitreous and slimy ; in the 
other 12, on the contrary, muco-purulent or, when it had to do 
with old purulent metritis or pyometra, wholly purulent. 
In a combination of nymphomania with prolapse of the vagina 
or of the vaginal portion of the uterus, there was found a muco- 
purulent discharge mixed with fecal particles, which were later 
drawn into the vagina by the spontaneous reduction of the pro- 
lapse when the cow assumed the standing position. 

If vaginal discharge exists, the hairs of the vulvar tuft are 
matted and the ventral surface of the tail, next to the vulva, 
soiled. 

The vaginal mucosa, in 15 % of the cases of nymphomania, is 
reddened, injected and swollen, the latter especially marked 
when prolapse of the vagina or vaginal portion of the uterus 
coexists. Verj' often one finds the symptoms of chronic infectious 
nodular vaginitis (nodular or granular venereal diseases of the 
cow ), such as a yellowish hue of the vaginal mucosa in those parts 
no longer inflamed, blanched vesicles and nodules no longer sur- 
rounded by inflamed areas, either grouped in one part or dissem- 
inated over the entire vaginal mucosa. More seldom, the mucosa 
is superflcially eroded as a result of therapeutic efforts. 

A comparatively frequent finding is retention cysts of the glands 
of Bartholini, varying from the size of a hazelnut to a fist and. 



184 Veterinary Obstetrics 

more seldom, vaginal polypi. There also occurs, quite exception- 
ally, at the line of demarcation between the vestibule and vagina 
or in the roof of the vagina about a hand's breadth posterior to 
the mouth of the uterus, a thin walled fluctuating retention cysf 
the size of a large fist, containing a grayish sero-mucous, odor- 
less fluid. The location and character of these cysts may best be 
determined by simultaneous examination per rectum et per vagi- 
num and through causing the former viscus to glide over the 
tumor. 

To the symptomatology of nymphomania also belongs the oft 
observed extraordinarily great relaxation and widening of the 
vagina, which here and there shows evident, horizontally di- 
rected scars and a very notably increased facility for palpating 
this organ, now so much more roomy. 

Very seldom one finds bj' the os uteri externum an abcess as 
large as a hen's egg containing thick, white pus and now and 
then beneath the os uteri externum as many as 6 polypoid growths 
varying in size from a pea to a pigeon's egg, or one to several 
fluctuating, spherical, cordiform retention cysts of Gaertner's 
ducts as large as a small hen's egg. 

Not at all rarely, there is found the vestigial remnants of the 
incompletely resorbed median walls of the Muellerian ducts, which 
we have already described ', that is, there exists immediately 
behind the vaginal portion of the uterus, perpendicular bands 
1-3 fingers in breadth and 1-3 cm. thick. They are easily en- 
gaged by the index finger, elastic, nonvascular and, in non-gravid 
animals with a thoroughly mobile uterus, are readily drawn far 
back into the vagina. These evidently may interfere, under cer- 
tain conditions, with the ejaculation of the semen into the cervical 
canal. 

Contrary to the views of Zschokke, who holds that, in nympho- 
mania, the OS uteri is closed, we are able to state that the nym- 
phomania resulting from ovarial cysts is intimately related to 
the abnormal dilation of the mouth of the uterus and of the cer- 
vical canal and that it is only very rarely, and chiefly in cases of 
small cysts occurring soon after calving, that nymphomania ex- 
ists without dilation of the os uteri. 

Approximately two to three times, annually we find an accumu- 



' Schweizer-Archiv. fur tierheilkunde, 1896, page 252. 



Nymphomania 185 

lation of urine in the vagina [urovagina {Vagina 2irinalis)\. 
This maladjr attacks old, feeble, nymphomaniac cows with large, 
wide vaginae and uni- or bilateral ovarian cysts. The quantity 
of urine found in the vagina varies between 500 and 750 grammes, 
is feebly slimy and shows with the Nessler reagent within 1 2 
hours after its removal a marked ammoniacal reaction, and after 
a few hours standing a very marked ammoniacal decomposition, 
which undeniably points to cow urine and excludes the sugges- 
tion of its being some injected fluid or an excretion discharged 
from the uterus. The accumulation of urine in the vagina is 
explained by the low pressure of the urinary stream while the 
animal is standing and the low lying, excavated vaginal floor 
about the urethral opening. 

The external os in cases of nymphomania in cows which have 
recently calved, also in all prolonged and well developed cases of 
nymphomania, is constantly penetrable for a lead pencil, little 
finger, index finger or, in cows very recently calved, for two 
fingers, and it was only in very recent cases of nymphomania 
and along with the existence of acute and severe chronic infec- 
tious nodular vaginitis (and especially when the latter has been 
handled with powerful irritants) that the os uteri was found 
closed in spite of the existence of cystic degeneration of the 
ovaries and sinking of the broad pelvic ligaments. Frequently 
the external os is penetrable for one or two fingers while further 
forward it is much narrowed or entirely closed. 

Under normal conditions, in non-pregnant cows and heifers 
which are not in estrum or have not been for a few days, as well 
as in those nymphomaniac cows in which the internal os is 
closed, there is found on the external os only a very small clot of 
a clear, tough mucus, while, in all cases of nymphomania with 
completely open os titeri, there is as a rule a hypersecretion. 

The exudate discharged from the cervical canal and ostium ex- 
ternum and accumulating first in the vagina in var3'ing quantity 
consists usually of vitreous, transparent, tenacious mucus ; 
more rarely of slimy, whitish, or yellowish white, thick or thin 
liquid pus, which, in cases of prolapse of the vagina or mouth 
of the uterus, may in addition be mixed with fecal particles. 

If closed, the os uteri is small, not at all or but slightly swollen, 
and is often recognizable merely as a small rosette, which may be 
moved backwards or forwards and projects but little beyond the 



i86 Veterinary Obstetrics 

surrounding tissues, with which it is continuous. In case of an 
open cervical canal, the lips of the os icteri are enlarged, smooth, 
velvet-like, infiltrated. In many instances, especially when 
there exists a prolapsus portionis vaginalis uteri due to recurrent 
cystic disease of the ovaries, there are one or two flaps which are 
readily recognized in the vagina as bodies as thick as the hand, 
broad and long, tongue-shaped and often infiltrated with blood, 
upon the surface of which one may recognize, by palpation, the 
OS uteri. 

Now and then there exists, as a result of chronic irritation in 
connection with the pathologic dilation of the cervical canal and 
the swelling of the vaginal portion of the uterus, in cows suffer- 
ing from cystic or fibrous ovarian degeneration, an enlargement 
and conspicuous firmness of the cei-vix uteri, sometimes slight, 
sometimes the thickness of the forearm or arm, and without any 
increase whatever in the size of the cornua. 

Passing to the changes in the uteri of nymphomaniac cows 
and heifers, recognizable bj- palpation, it is to be pointed out 
that the size of the organ in quite recent and not severe cases 
must now and then be regarded as normal. So, for example, 
we observed in one mild and very recent ca.se of nj-mphomania 
in a cow which had aborted at the end of the fourth month of 
pregnancy, eight weeks after the abortion, ,a bilateral sinking of 
the broad pelvic ligaments, a large ovarian cyst in the right 
ovary, normal volume of the uterus and closed uterine os. 

However, in the great majoritj' of nymphomaniac cows, the 
patients show a very variable degree of increased volume of the 
uterus, either i7i toto or chiefly only in one horn. Often the uterine 
body at the point of origin of the cornua is only slightly thick- 
ened, the size of a child's arm ; in other cases, as thick as a 
man's arm. 

Simultaneous with the increased circumference, there occurs 
also a varying elongation of the uterus to the extent of 2 to 3 
times its normal length, whereby its anterior end projects far 
into the abdominal cavitj'. 

In asymmetric uteri the right horn is greater in 75% of cases 
and only exceptionally is one horn found to be normal while the 
other is importantly increased in circumference and length. The 
consistence of the uterus, which is never abnormally sensitive, 



Nymphonia7iia 187 

is uniform, soft-elastic, more seldom tense-elastic, and then dur- 
ing the existence of estrum. 

From the above facts and the post mortem findings yet to be 
related, it is indicated that cystic and cysto-fibrous degeneration 
of the ovaries almost uniformly lead to a non-infectious chronic 
catarrhal endometritis and only seldom to chronic muco-purulent 
endometritis or to chronic purulent endometritis, which makes it 
self evident that an impregnated ovum could not become attached 
to the uterine wall to undergo development into a fetus. Rela- 
tions analogous to those existing between cystic and cysto-fibrous 
ovarial degeneration and the sinking of the sacro-sciatic liga- 
ments hold good also between the former and the enlargement of 
the uterus. 

In bilateral cystic degeneration of the ovaries there exists no 
definite relation between the size of the cysts and the increased 
circumference of the uterus, which is usually symmetric, rarely 
asymmetric. In cases of unilateral formation of cysts the 
entire uterus is frequently uniformly larger and longer or, on 
the other hand, the enlargement may be confined to the cornu 
leading to the affected ovary. 

Finally, it must be conceded that, as a general rule, the symp- 
toms of nymphomania are referable to the ovaries themselves, 
which are the chief and almost exclusive seat of the anatomo- 
pathologic changes, and that diseases of the uterus and vagina, 
without involving the ovaries, can only very rarely lead to symp- 
toms of nymphomania. On the other hand we have observed, 
and verified our diagnosis hy post inorteni examinations, that in 
both uncastrated and castrated cows, cysts in the broad liga- 
ments and in the oviducts, and hydatids in the oviducts or am- 
pullae can cause well marked nymphomania. 

As abnormalities of the ovaries which we have definitely recog- 
nized and verified in connection with nymphomania in cows we 
may relate : 

1. The formation of cysts or vesicles of the follicles — hyper- 
trophy of the ovisacs. 

According to Zschokke three genetic forms of these may be 
differentiated : 

a. Those which spring from the Graafian follicles and are to 
be designated as hj'drops folliculorum. 



1 88 Veteri7iary Obstetrics 

b. Those which emanate from the Pfliiger sheaths or from 
■ yellow bodies. 

c. Cysts which originate in hemmorrhages or colloid degenera- 
tion of cells, especially in malignant neoplasms. 

Because subclasses b and c produce nymphomania only very 
rarely and consequently possess no great clinical importance, 
the subject, as related to these, will not be pursued further here. 
We will simply remark that not every ovarian disease in- 
duces nymphomania and that an ovary, under some conditions, 
may possess a tumor as large as the fist without producing 
symptoms of nymphomania ; indeed a cow may have a badly 
degenerated ovary, as we found in one particular case, and 
nevertheless show normal estrum and become pregnant. We 
have also repeatedly observed that, when but one ovary has 
undergone even severe cystic degeneration, estrum maj' be 
normal and impregnation occur. 

Uudoubtedl}', the most important and common disease of the 
ovaries leading to nymphomania is the cystic degeneration, which 
may be confined to only one or two ovisacs and then be desig- 
nated as solitary cyst formation, in contradistinction to multiple 
cyst formation, in which numerous Graafian follicles become hy- 
pertrophied in equal or unequal degrees. 

In regard to the formation of solitary cysts and fibrous degen- 
eration of the ovaries, we would here make the supplementary 
statement, or more properly, repeat that the right ovarj' is more 
frequently found diseased than the left, a fact which stands in 
an intimate relation with the greater functional activity of the 
right gland and the more frequent occurrence, approximately 
70%, of impregnations in the right horn. 

It is also interesting to note the fact, amply verified by us, 
that large cysts, which, it is to be assumed, have required a 
longer period of time for their development than do smaller ones, 
cause no visibh' greater symptoms of nymphomania, but that the 
volume of the cyst stands in no constant relation to the intensity 
of the symptoms. 

The size of the solitary cysts varies from that of a hazelnut to 
a hen's egg or a goose egg or even as large as a fist. In this 
relation, it should be here remarked that, in cattle. Graafian fol- 
licles measuring 1.5 cm. and upwards in diameter are to be re- 



Nymphomania 189 

garded as cysts, since, in these, according to Rubeli, (vid. pages 
163 and 164) no ova are ever found. 

They are located either comparatively peripherally or centrally 
and lead, in both instances, to atrophy of the ovarial paren- 
chyma, which, under the pressure of the cysts, may completely 
disappear. By rectal palpation, the peripheral, solitary cysts, 
which are frequently thin walled, may be diagnosed by the en- 
largement of the ovary, upon which they appear as elastic, tense, 
smooth, fluctuating eminences. In thick walled peripheral cysts 
the gland feels more firm and elastic. 

More difficult than the diagnosis of solitary peripheral cysts is 
the recognition of the solitarj^ central cysts, which are common 
and lead to every grade of nymphomania. One or two of these 
may be located in the center of the gland, never project above 
its surface and are surrounded by a layer of ovarian tissue as 
much as 8 mm. thick. Here, the diagnosis is to be based upon 
the size of the ovary, the increased tension, the less readily com- 
pressed, elastic surface and the non-crushable character of the 
gland ;!>tfr rectum and especially per vaginam. 

It is an interesting observation that, in a cysto-fibrous de- 
generated ovary, there is now and then found one, rarelj' two 
large solitary cysts, after the crushing of which there still re- 
mains an abnormally large, firm, solid ovary. We have also 
found that after vigorous crushing of a cysto-fibrous degenerated 
ovary in exceptional cases there develop, after the lapse of a few 
weeks, cysts from the size of a hickorynut to that of a small 
hen's egg and that, by periodic compression and massage, the de- 
velopment of small central cysts may be accelerated, as a con- 
sequence of which they may then approach the periphery. 

Another finding, to which we have already referred and which 
admittedly occurs rarely in nymphomaniac cows, consists in the 
formation of multiple cysts by which several ovisacs in various 
parts of the ovary hypertrophy and acquire the dimensions of 
large peas, owing to which those most peripherally located pro- 
ject slightly beyond the surrounding surface of the ovary. The 
disseminated arrangement of the numerous follicles of approxi- 
mately uniform size, as well as the general, though not constant, 
absence of corpora lutea, indicates multiple cyst formation and 
that they are not normal, ripe ovisacs. 

2. A quite frequent cause of nymphomania consists of the 



igo Veterinary Obsteh-ics 

formation of multiple cysts, accompanied by connective tissue 
hypertrophy or scelerosis of the ovaries, in which a cut surface 
reveals several Graf&an follicles, very small, up to as large as a 
pea, embedded in much firm, white connective tissue. Such 
ovaries vary in size from that of a hickory nut to a hen's egg, 
are firm and hard, can not be crushed, and, now and again, there 
are still present 3'ellow bodies. 

Contrary to the deductions of Zschokke and Simon, we were 
in a position 14 times during the last year to recognize with cer- 
taint5' the presence, sometimes of large, at others of small, corpora 
lutea in cystic or cysto-fibrous degenerated ovaries, and, indeed, 
one, two, or even three of them in one ovary, (vid. post mortem 
findings in Nos. 2 and 3.) On the whole, there is no substantial 
ground for the opinion that, in intermittent nymphomania in 
cows, yellow bodies may not still be formed. 

Definite sclerosis of the ovaries {sclerosis ovarii') in which all 
appearances of ovulation cease, such as normal Graafian follicles 
and ir&sh. corpora lutea, never determines nymphomania, but leads, 
according to our observations, when bilateral, to absence of 
estrum, though, when one ovary remains normal, the animal may 
conceive. Selerotic and cicatricially contracted ovaries are the 
size of a hazelnut to that of a hickory nut, smooth, and of a 
uniformly firm or hard, nodular consistence. 

3. Yet another disease of the ovaries, which, however, leads to 
" Stillochsigkeit " or dumb estrum consists of the development 
of ovarial cysts containing yellowish, sero-fibrinous, pap-like 
fluid or of blood cysts. The first mentioned formation, which is 
very rare, varies in size from a hen's egg to a fist and feels like a 
sac filled with quicksilver. When these are crushed in living 
cows a granular, thick, gravy-like mass escapes. 

4. In aged, good milk cows there occurs in rare instances, as a 
cause of n3'mphomania, ovarial dropsy (hydrops ovarii). In this 
disease the ovaries are soft, flabby and flattened. 

5. A very rare cause of nymphomia in cows, not to exceed 
0.5 •% in our clinic, so far as we could determine, is tubercular 
ovaritis (oophoritis tuberculosa).^ These cases run their course 
with and without symptoms of nymphomania and sinking of 
the sacro-sciatic ligaments. 



' E. Hess, Sctweizer-Archiv. fiir Tierheilkunde, 1S91, page 161. 



Nymphomania 191 

In one cow with ovarial tuberculosis, which- led to abortion in 
the sixth month of pregnancy, the left ovary revealed one cyst 
the size of a hazel nut and one yellow body. The right ovary 
in the living cow was the size of a child's head, uneven, nodular, 
slightly mobile and adherent to the right horn of the uterus. In 
another case, each ovary was like a large, hard bunch of grapes, 
covered over with firm round nodules from the size of a pea to 
that of a hazel nut. Both oviducts were as large as the index 
finger, serpentine, rigid and likewise invaded by hard nodes 
from the size of a pea to a hazel nut. 

Finally, as further causes of nymphomania there occur very 
rarely : oophoritis, abscesses in or near the ovaries, angioma of 
the ovary, hydrosalpinx or dropsy of the oviducts, perimetritic 
abscesses following perforation of a uterine horn, and cysts in the 
broad ligaments of the uterus. 

As a result of retention of the placenta and consequent septic 
metritis there follows adhesion of the ovaries and uterine horns 
to the surrounding parts, which may cause nymphomania, and 
the ovaries become so hidden by the adhesions that they are 
scarcely, if at all, recognizable by rectal palpation and are but 
very slightly mobile. In a great many cases, in addition to these 
changes, the ovaries undergo cystic or cysto-fibrous degeneration, 
and attain the size of a hickory nut or hen's egg ; at times, 
although quite seldom, the septic metritis, in addition to the ad- 
hesions, leads to the formation of abscesses in the ligamentous 
apparatus of the ovary and in the ovary itself, which latter con- 
dition from a therapeutic standpoint warns one to be cautious. 

In a 3j^-year-old, valuable premium winning cow, which had 
suffered from retained placenta following abortion and later from 
purulent endometritis, there developed, as a result of rough 
handling of the vagina by the owner, which irritated the uterus, an 
extensive adhesion of the valvida vaginalis and, within a few days 
thereafter, there occurred an extensive accumulation of pus in 
the vagina {pyovas:ina) amounting to fully 3 liters. After opera- 
tive withdrawal of the very fetid pus, an examination of the 
sexual organs revealed an open cervical canal, which permitted 
the passage of the little finger. There was also present purulent 
metritis ; the right ovar}' was the size of a hazelnut and in the 
left uterine horn there was a tumor (abscess) as large as one's 



192 Veterinary Obsteh'ics 

fist, round, smooth and fluctuating. The cow showed normal 
estrum 14 daj's after the operation. 

6. Supplementary' to the foregoing, we shall here submit, 
through the courtes}' of Professor Dr. Gillebeau, the appended 
postmortem findings relative to cj'Stic degeneration of the ovaries: 

1. A cow which had been handled by us for a long time was castrated on 
December 3, 1903. The right ovary weighed 20 grammes and contained in 
its center 2 follicles the size of peas ; the one had the ordinary- contents, the 
other was filled with clotted blood, evidently the result of preceding severe 
crushing. Otherwise, the ovarj' was in a state of advanced fibrous degener- 
ation. The walls surrounding the follicles were 7 mm. thick. 

The left ovary, weighing 30 gr., was as large as a hen's egg, 4 cm. in 
diameter and contained 5 peripheral Graafian follicles, as much as 5 mm. in 
diameter, and one central Graafian follicle, i cm. in diameter, with yellow 
walls and contents consisting of a 3'ellowish-red fluid serum and blood 
clots, which was likewise referable to the previous crushing of the organ. 
Otherwise, this ovary also showed extensive fibrous degeneration. 

Anatomo-pathologic diagnosis ; sclerosis of the right ovary and cysto- 
fibrous degeneration of the left. 

2. A 6-3'ear-old cow. Six months pre\iously, ovarial C3'sts had been 
crushed for the first time ; later, they recurred. The patient suffered also 
from vaginal prolapse. Slaughtered on the 21st of December, 1905. The 
vagina was decidedly wide, the mucosa covered with much tenacious mucus. 
The habitually prolapsed portion was intensely hyperaemic, the lips of the 
OS uteri swollen, the cervical canal penetrable for one finger. Weight of 
uterus 900 grammes, as against a normal weight of 600 to 700 grammes. 
The exaggerated weight is referable to the hypermaemia of the cervi.x. 

Uterine cavity normal. Left ovary somewhat enlarged, tissue dense with 
one follicle of the size of a pea and 2 yellow bodies. The right ovary con- 
sists of a cyst the size of a hen's egg, with clear contents, a moderately 
large yellow body and a vestige of normal ovarian parenchyma. 

Diagnosis : Chronic colpitis and cystic degeneration of right ovary. 

3. A 2^^ year heifer, which had not been pregnant, was first handled on 
May 8, 1895, because of a cyst in the left ovary of the size of a hen's egg. 
On the 2Sth of the same month there was recurrence of a cy>t in the same 
ovarv, and 4 weeks later a recurrence of cysts in both glands. She was 
slaughtered August loth, 1895. 

Anatomo-pathologic findings : 

The dorsal vaginal arch is dispropoitionately deep, so Vnai. 'Oa.^ os uteri 
externum is not directly toward the vulvar opening but downwards against 
the vaginal floor. Above the os externum there lay a broad lip, which, in 
the usual condition, scarcely covered the os, but when hyperaemic certainly 
must have covered it completely. Uterus and oviducts were normal. 

The right ovar3' weighed no grammes. Its length was 3.5 cm., breadth 
2.5 cm. and thickness 1.5 cm. At various points on the surface (there ap- 
peared yellow bodies 3-7 mm. broad. Through the dense fibrous tissue of 



Nytnphomatiia 193 

the gland there could be seen several Graafian follicles. The contents of 
one cyst of the size of a hickory nut were bloody. The left ovary weighed 
55 grammes. Its length was 3.3 cm., its width 2.3 cm. and thickness 1.3 cm. 
The periphery was smooth. Upon section, this ovary was found to have 
undergone extensive fibrous degeneration and it contained a few follicles. 

Pathologico-anatomical diagnosis : indurative cystic ovaritis of right 
ovary, and indurative oophoritis of left. 

4. In an aged nymphomaniac cow which was slaughtered on the 12th of 
November, 1904, the mouth of the uterus was penetrable for one finger, the 
lips of the OS were slightly swollen, the uterus somewhat" enlarged, the right 
uterine horn was empty. To it was suspended an abscess in the form of a 
pedunculated tumor. The right oviduct was dilated, its ovary the size of 
an apple and affected with two cysts as large as hickory nuts. 

The left uterine cornu contained some mucus and was adherent to the 
anterior extremity of the bladder. The left oviduct was as thick as a man's 
finger and contained some pus. The left ovary was small and contained 
some pea-sized follicles. 

Pathologico-anatomical diagnosis : encapsulated abscess of right uterine 
horn, adhesion of left uterine horn to the urinary bladder, left pyosalpinx 
and cystic degeneration of both ovaries. 

5. A three year old cow, which had not been pregnant, had shown normal 
estrum for 3 months but had not conceived ; ovarial cysts and nympho- 
mania then developed. 

Post mortem examination on December 13th, 1905 revealed : the lips of 
the OS uteri externum small, the cervical canal closed. In the cervical 
canal there was some viscid mucus. Weight of uterus 375 grammes. 
Uterine cornua very small. Uterine mucosa pale. Cotyledonal nodes 
normal. Right ovary, weighing 6 gr., contained several small yellow bodies 
and 6 pea-sized follicles. I/eft ovary weighed n grammes and was normal. 
Pathologico-anatomical diagnosis : Multiple formation of cysts. 

6. A cow which had been nymphomaniac for ten months, with marked 
sinking of the broad ligaments of the pelvis, revealed the following upon 
post mortem examination : lips of os uteri somewhat swollen, injected 
clear mucus in the cervical canal, in the walls were very hard areas sug- 
gestive of " cancer. The uterus somewhat enlarged, peritoneal surface 
smooth. In the right horn was an intensely pigmented area, 3x1 cm. in ex- 
tent. Right oviduct dilated, its walls thin, its ampulla adherent to the 
ovary and distended into a thin walled, pear-shaped cyst 15 x 9 cm. in size, 
filled with a clear, serous fluid. The ovary, concealed in the adherent 
ampulla, was normal in size and contained yellow bodies. 

Left oviduct also dilated. Fimbriated end adherent, leading to the ex- 
istence of an hour-glass-shaped sac 12 cm. long and 9 cm. broad at its 
widest point. It was thin-walled and filled with a clear yellowish serosity. 
The left ovary was normal in size, concealed in the ampulla and contained 
one large corpus luteum. The arteries of the broad ligament were some- 
what large and inflexible. 

13 



194 Veterinary Obstetrics 

Pathologico-anatomical diagnosis : bilateral serous salpingitis witli oblit- 
eration of the opening of the ampullae through adhesion of their margins 
to the surface of the ovaries. 

7. A yearling goat which had not shown estrum at all, nor nympho- 
mania, was slaughtered on October 26th, 1905. 

The post I[mortem examination revealed : uterus symmetric, its body 
3 cm. and its horns 7 cm. long. From the right ovary there hung by a 
pedicle 6 cm. long a spheroidal, free-swinging tumor 8 cm. in diameter. 
This 2 celled tumor contained a freely flowing yellowish fluid with numer- 
ous fibrin floccules. The left ovary was likewise enlarged, 3 cm. broad, 
fluctuating, three chambered, the cavities containing a clear, pap-like fluid. 
Pathologico-anatomical diagnosis : congenital ovarial cystic degeneration. 

S. A 2 year old brood sow, apparently perfectly sound, which had already 
borne two litters of pigs, being fat, was slaughtered on May 8, 1906, and 
revealed the following : 

The ovaries were each as large as a fist and weighed together 500 grammes. 
Each consisted of numerous thin-walled fluctuating cysts, varying in size 
from a nut to an egg, the contents consisting of a transparent serum. In 
the right ovary there was a yellow body as large as a pea. 

Pathologico-anatomical diagnosis : cystic degeneration of both ovaries. 

The contents of solitary ovarial cj'^sts iisualty consist of a 
watery, transparent fluid having an alkaline reaction and con- 
taining albumen ; less freqtiently the contents are yellowish, 
reddish or bloody. 

It has been recognized for .several decades that the thin walled 
peripheral ovarian cj^sts tend to recur. The recurrence involves 
largely for a long duration of time the same ovary ; at other 
times it alternates, first one, then the other ; or both may be- 
come involved simultaneously or in rapid succession. It is 
worthy of note that, strictly speaking, the symptoins of nympho- 
mania resulting from recurrent ovarian cysts are frequently 
more marked and intense than those accompanying primary 
cysts. Exceptionally in cows which have developed " stillochsig- 
keit," or dumb estrum, as a result of ovarial cysts, and these 
have been crushed, intense erethetic nj'mphomania may occur 
8-14 days later because of the recurrence of the cysts. 

An additional, though very rare, observation included three cows 
which were handled because of recurrent cysts, after which concep- 
tion followed but, during the entire span of gestation, sexual desire 
was easily excited so that they would neither graze quietly nor 
could they be turned out with other cows to drink and, even on 
the day before calving, attempted to ride other cows. In two of 



Nymphomania 195 

them (the third was sold)the ovaries felt normal a few days after 
parturition and contained no yellow bodies ; four months after 
parturition both animals showed bilateral cystic degeneration of 
the ovaries and again well marked nymphomania. 

The length of interval between recurrences is very variable in 
different individuals and ranges between a minimum of 3 and a 
maximum of 120 days, between which occur periods of 8, 12, 14, 
16, 20, 27, 30 and 60 days. Often we find, in heifers and young 
cows, at the beginning, long and regular intervals ; later short and 
irregular, or the reverse. So, for example, we observed the : 

first formation of cysts no days after calving, in both ovaries ; 

second formation of cysts 120 days after calving, in the right 
ovary ; 

first formation of cysts 60 days post partum, in both ovaries ; 

second formation of cysts 120 days post partum, in right 
ovary ; and 

third formation of cysts 160 days post partum, likewi.se in 
right ovary. 

One three year old cow which had not yet been pregnant 
showed cysts in the left ovary three times in succession at 
intervals of one month each. Three months later, both ovaries 
had undergone cysto-fibrous degeneration and estrum now re- 
curred every 8 daj's. 

In another three year old cow which had not been pregnant, 
estrum recurred at first every 28 days and lasted 2 days ; later 
the patient, suffering from recurrent bilateral ovarian cysts, was 
in estrum every 12 da3^s. 

A 2i^ year old heifer, which had not been pregnant, showed 
at first a small cyst in the left ovary, eight days later a cyst as 
large as a hazelnut in the same gland, and, further, 15 days later, 
a cyst in each ovary the size of a large hazlenut. 

When the period elapsing between the recurrence of cysts is 
comparatively long, there frequently occurs one or two normal 
estrual periods, the cow appearing in all ways normal but failing 
to conceive. 

The frequency of recurrence is extremelj' variable. In 50 ^ 
of the cases, after the cysts have been crushed, they do not re- 
cur until after the next calving. In individual cows, the forma- 
tion of cysts occurs almost immediately after each calving, and rel- 
atively such animals very frequently conceive after proper hand- 



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Nymphomania 197 

ling. The recurrence of cysts for 3-6-10-15 times is not rare ; 
it then frequently leads to atrophy and a fibrous thickening of 
the ovary (vid. table). 

The size of the cysts and thickness of their walls stand in a 
certain relation to the intervals of recurrence, in that in shorter 
intervals the cysts are small and thin walled, in longer intervals 
they are usually larger, their walls thicker and their rupture 
more difficult. 

The post mortem findings in the case detailed in the table 
upon the opposite page were as follows : In the right ovary 
there were recognizable four scars and a very thin-walled 
cyst the size of a hen's egg which, in consequence of the for- 
mation of partitions, was separated into three sections. Of 
real ovarian tissue only a trace remained. The left ovary, also 
exhibiting four well defined scars, was the size of a hickory nut 
and contained a hazelnut sized cyst. The slightly enlarged 
uterus weighed i kilogram and contained some mucus. It is an 
interesting fact that all the cysts could be ruptured per rectum, 
that, further, there was constantly a restoration of the tension . 
of the broad ligaments of the pelvis after 4 days ; the quantity 
of milk increased and the prolapse again vanished four to ten 
days after the operation. 



B. ABSENCE OF ESTRUM 
Dumb Estrum. " Stillochsigkeit." 

We have already related that sinking of the broad ligaments 
of the pelvis, in connection with cystic or cysto-fibrous degenera- 
tion of the ovaries, is not necessarily associated with nympho- 
mania or abnormal sexual excitement but that there occur cases in 
cows in which there is an absence of, or only a slight degree of, 
sexual excitement. In these animals, absence of sexual excite- 
ment does not interfere with their feeding and they constantly 
tend to become fat. Accompanying this difficulty, there is 
usually present the same sinking of the hips as in nymphomania. 
The history of the animal is about as follows : after calving 
there is an entire absence of estrum or the broad ligaments of 
the pelvis recover their normal tension in spite of the ex- 
istence of the light, clear, albuminous discharge from the vagina ; 
no estrum appears. After 3-5 weeks post partum there appears, 
and remains constant, a sinking of the broad ligaments of the 
pelvis although, during 4-6 months after calving, the cow ex- 
hibits no signs of estrum. Or, in other cases, estrum has oc- 
curred for the last time 6-8 months previously, at which date 
the cow was bred and, because of the non-recurrence of estrum 
and the general behavior of the animal, it has been supposed 
that she was pregnant. This, in spite of the absence of a 
vaginal discharge, was evidently an erroneous view. 

The condition is generally due to a cystic degeneration of the 
ovaries, in which the cyst wall is not usually so tensely stretched 
as in nymphomania but is more flaccid ; atrophy of the ovary ; 
connective tissue degeneration (cicatricial degeneration, ovariaL 
sclerosis) and, in a few cases, to parturient paresis, that is, as a 
result of the consequent changes taking place in the ovaries after 
parturient paresis. In such cows we were repeatedly able to 
recognize, after many weeks, a persistent yellow body with ab- 
sence of estrum or a cystic, or more especially a cysto-fibrous 
degeneration of one or both ovaries, with sinking of the sacro-^ 
sciatic ligaments, the os uteri open to a degree to admit the passing 
of a finger, and the uterus enlarged as a result of mild chronic 
catarrhal endometritis. Seven times we recognized ovarial cysts. 



Absence of Estrum 199 

in cows which had previously suffered from parturient paresis 
and then showed dumb estrum with sinking of the broad pelvic 
ligaments. In one instance these phenomena were associated 
with a persistent yellow body in the right gland. In five of 
these cases, in spite of extreme sinking of the broad ligaments of 
the pelvis and marked bilateral cystic disease, there was not a 
trace of estrum to be seen. 

In one dumb estrual cow, presumed to have been 6 months 
pregnant and showing extreme sinking of the broad ligaments, 
there was present in the right ovary a large cyst and, in addition, 
an extensive pyometra with purulent discharge. In another 
dumb estrum cow, affected with extreme sinking of the broad 
ligaments, the two ovaries hung far down in the peritoneal cavity 
and each contained a large C5'st, in addition to which there was 
a perivaginal abscess present. 

A fat young cow, a few hours subsequent to normal parturition, 
exhibited sexual excitement and attempted to mount the milker. 
The broad ligaments resumed their normal position very promptly 
but sunk again to an extreme degree on the sixth day and re- 
mained permanent thereafter, while estrum failed entirely to 
recur. In the right ovary there was recognized a cyst the size 
of one's fist, in the left a cyst the size of a large hazelnut. 

One observes now and then, in fat cows or deep milkers which 
are kept stabled, a marked sinking of the broad ligaments of the 
pelvis with large cysts in the ovaries without any symptoms of 
nymphomania. The latter tends to appear first after the animal 
has run at pasture for several weeks. In addition to the symp- 
toms of cystic degeneration already related, the following phe- 
nomena are of great clinical interest. 

C. Prolapsus Vagina. 

There occurs with relative frequency in non-pregnant cows, 
seldom in heifers, far more frequently in dumb estrual cows, an 
habitual prolapse of the vagina. According to our investiga- 
tions, extending over a number of years, at least 50 % of the 
cases of prolapse of the vagina occur in nymphomaniac animals, 
which must generally be referred to the persistent occurrence of 
small or large ovarian cysts, seldom to cysto-fibrous degeneration 
of the ovaries or to ovarial cysts in combination with chronic 
catarrhal or purulent endometritis. We have good proof that 



200 Veterinary Obstetrics 

the existence of the prolapse of the vagina in non-pregnant cattle 
is due to a chronic, permanent irritation of the genital organs 
owing to the presence of diseased ovaries, because, if we can 
bring about a normal state of the ovaries, the sinking of the broad 
ligaments, the swelling of the vulva and the fiacciditj' of the vagina 
all cease in from seven to twelve days, while the milk flow in- 
creases. Furthermore, if ovariotomy be performed upon these 
animals, the prolapse of the vagina disappears in 95 % of the 
cases, thus demonstrating the co-ordination between the cysts 
and the vaginal prolapse. 

We should not underestimate, as a cause of continued or newly 
occurring prolapse of the vagina during the first two to six weeks 
afterbirth, an acute or chronic catarrhal or purulent endometritis 
due to the relaxed state of the pelvic diaphragm. 

As prodromata of vaginal prolapse due to ovarian cysts, there 
is observed a sinking of the sacro-sciatic ligament and a swelling 
of the lips of the vulva. As a general rule, the prolapse does not 
occur at the same time as the formation of the ovarian cysts or 
the sinking of pelvic ligaments, but follows these some days or 
weeks later. It often appears simultaneously with a well marked 
erethetic nymphomania. Now and then the quantity of milk 
sinks one-half and along with it sometimes occurs a "holding 
up " of the milk. In rare cases, some time after the appearance 
of prolapse of the vagina there also appears a slight prolapse of 
the rectum. In one such case we identified on the right side an 
ovarian cyst the size of a hazelnut and in the left ovary a greatly 
hypertrophied corpus luteum. 

The prolapse often involves only the superior wall of the vagina. 
The swollen lips of the vulva are clearly sunken forward and ap- 
parently small ; in many cases they hang loosely; in the superior 
half of the vulva they are folded and wrinkled. The wrinkles 
extend regularly from above and outward, downward and in- 
ward, and are almost wholly caused by the muscular contraction 
of the walls of the vestibule of the vagina or possibly are a result 
of the flaccidity of the radiating muscle of the vulva and common 
fibers of the sphincter ani externus and constrictor cunni, 
causing an invagination of the lips of the vulva, that is, an 
entropium vulvae spasticus, from which, in place of the normal 
mucous margins of the vulva, two haired cutaneous surfaces 
come in contact. The last related symptoms (wrinkling and en- 



Absence of Esti-um 2or 

tropiiim formation of the vulvar lips) are, from a diagnostic, 
pathonogmonic and superficially visible standpoint, of much im- 
portance. Moreover, the vulvar opening is frequentlj' much 
elongated, the vestibule of the vagina markedly enlarged and 
flaccid, so that, in individual cows, air may readily become aspired 
into the enlarged vaginal cavity, which may become greatly 
distended, so that, upon palpation per rectum, the vagina may be 
found tensely inflated with air, in order to evacuate which it is 
necessary to apply pressure and backward massage to the vagina, 
per rectum.' 

If, in addition to the prolapse of the vagina, there is also en- 
dometritis, the OS uteri is found sufHciehtly open to admit the 
index finger : out of it flows a mucous or muco-purulent exudate 
and the uterus shows an increased size. In cows which have 
suffered from prolapse of the vagina dependent upon ovarial cysts 
and have not been treated for these, but have had vulvar sutures 
applied to overcome the condition, there is now and then violent 
straining and pressing, on which account practitioners who are 
not experienced replace the vulvar sutures by a vaginal bandage 
or truss in order to give the prolapse more room. It is scarcely- 
necessary to suggest that, in order to determine the etiology and 
rational therapeutics in each case of prolapsed vagina in non- 
pregnant cows, palpation per vaginam and per rectum should be 
employed and that these rules are constantly applied in this 
clinic. 

D. Prolapsus Portionis Vaginalis Uteri.' 

Quite analogous, from the standpoint of cause and curative 
means, to the prolapse of the vagina is the prolapse of the 
vaginal portion of the uterus. In ver}' great fiaccidity of the 
genital organs this prolapse can be brought about artificially by 
drawing backward upon the os uteri. 

B. Prognosis. 

Cystic degeneration of the ovaries offers a favorable prognosis 
in general, since, in our statistics, certainly 70% of nympho- 



[' In this relation it needs be borne in mind that the vagina possesses the 
power of ballooning, much as related here. ] 

^ E, Hess, Schweizer Archiv fiir Tierheilkunde, 1886, p. 74 : 1890, p. 
212 and 1896, p. 228. 



502 Veterinary Obstetrics 

maniac cows have been restored to fertility and agafn become 
pregnant. The remainder were mostly rendered at least 
temporarily quiet. The prognosis is the more favorable when 
the veterinary handling is begun early and the animal is not fed 
too intensely. 

The prognosis becomes doubtful in fat heifers which have 
never been pregnant, in old, deep-milking cows with depressed 
regenerative powers, as well as in cases of old standing and those 
in which the cysts have recurred six or more times. 

Estrum and pregnancy do not occur in cows whose ovaries 
have undergone senile atrophy or which have suffered atrophy 
from the rupture, by compression, of ovarian cysts. It should be 
noted, however, that a very small remnant of ovarian tissue may 
possess much regenerative power because there may form within 
six days in some cases either large corpora lutea or one or two 
cysts, as our collections very well show. 

A spontaneous recovery or rupture of the cysts has been ob- 
served b\' us in a few cases of cows which had calved normally 
two to six weeks before. And it is well to observe in our present 
state of knowledge that it was not the use of posset or sillabub 
that caused the rupture of the very thin walled cyst any more 
than the extreme filling of the rumen, which pressed upon the 
ovaries while the animal was lying down on a slanting floor, or to 
severe pressure of feces. 

Nymphomaniac cows which are not handled tend to become 
emaciated, wasted and, finally, to succumb to cachexy. 

In reference to the prognosis of prolapsus vaginae of non- 
pregnant cows, experience teaches that, in so far as the causes 
can be removed, and the atony of the pelvic diaphragm is not 
extreme, the prolapse disappears within twelve to twenty days 
or, if the cysts recur, the prolapse likewise returns. 

In hydro- and pyometra, the outlook needs be based upon the 
duration of the affection, the volume of the collection, and 
chiefly upon the facility with which the ovaries may be reached 
and restored to their normal condition through rectal or vaginal 
manipulation ; if these can be corrected, the results are often 
excellent. 



THERAPY 

A. Medicinal. 

We cannot undertake to discuss all the remedies which have 
been proposed by veterinarians of early times for the relief of 
nymphomania in cows, nor those which have actually been put 
in use and have from time to time won high repute in those 
regions where inner palpation of the genital organs of nympho- 
maniac cows is very rarely practiced. 

To these belong venesection, magnesium sulphate and sodium 
sulphate, in combination with amaris, aromatics and etherial oils, 
as : Rad. Gentian, Hetb. Centaur minor, asafetida, Rad. Angelic, 
Rhiz. Calami, Cantharid. pulv., Fol. Menth. Piperit., Frud 
Foeniculi, Frud Jimperi, Piper Nigr. pulv., Rad. Valeria^i ; also 
such depressant drugs as Camphor, Potassa Bromid, etc. 

Slight sinking of the sacro-sciatic ligament dependent upon 
atony of the genital organs frequently recovers promptly after 
the use of the following : — 

I^ Magnesium Sulphate 300 grams 

P. Gent. Rad. 

" Cinchonae Cort. aa 150 grams 

" Cascarilla " 100 grams 

Aq. font. q. s. ut fiat 
decoct, ad. colat. 8000 cc. 

Sig : — One pint internally 2-3 times daily. 
Sulphate of iron, 5-10 grams dissolved in 4 liters of water or 
camomile tea, is used for the same purpose. 

A yet greater reputation for influence upon the relaxed sacro- 
sciatic ligaments and genital organs is accredited to resinous and 
balsamic substances, especially Ol. Terebinth. The latter may 
be given in doses of 15-20 cc. in Yi liter of milk three times 
daily. Turpentine, camphor and asafetida has each the disad- 
vantage that, when given for several days, it imparts an unpleas- 
ant flavor to the milk, and, although we have prescribed turpen- 
tine or m3'rrh frequently, we have never been able to observe 
the disappearance of ovarian cysts as a result of its use. 

In earlier times, they bathed the loins and sunken sacro- 
sciatic ligaments daily with cold water or applied with massage 
203 



204 Veteriiiary Obstetrics 

spiritous, feeblj' stimulant drugs or even volatile liniments, ol. 
turpentine, rape oil i :5, or compound cantharides ointment. Fric- 
tions over the sunken pelvic ligaments are merely of theoretic 
interest. 

The value of medicinal handling is doubtless frequently over- 
estimated ; nevertheless, it constitutes, in many cases, when 
applied alone, a valuable method, which is not to be underesti- 
mated, and in many other cases, a highly important adjunct in 
combination with operative handling. In those cows where 
estrum appears shortly after parturition and the uterus has not 
undergone normal involution and is flaccid and slight catarrhal en- 
dometritis arises without being caused by any recognizable anato- 
mical changes in the ovaries, but resulting rather from a depres- 
sion of the vital energj', stimulants and tonics exert a very 
beneficial effect. 

In catarrhal, muco-purulent or purulent endometritis, in addi- 
tion to internal medication, it is advisable to douche out the 
vagina dail}' with astringent and disinfectant decoctions or solu- 
tions, such as sol. plumbi. subacet. 15:1000, alum ust, 0.5-1%, 
Zinc Sulph. 0.25-0.5%, Creolin 0.5-1 %, I^ysol 0.25-1 %, etc. 

Under all conditions, the beginning veterinarian has to behave, 
in the handling of nymphomaniac cows, so far as he will not 
seriously injure his repute or practice, with some respect toward 
ancient customs and ps5'chologic considerations and, in opposition 
to views recently expressed in veterinary periodicals, endeavor 
to express himself frankly, tactfully and without reserve to the 
owner. 

B. Operative Handling of Ovarian Cysts. 

The operative therapeutics of ovarian cysts should always be 
preceded b}' a painstaking consideration of the anamnesis and a 
thorough examination of the special reproductive apparatus, as 
well as the other organs of the body. The proper arrange- 
ment of the data derived from the study of the case absolutely 
demands the entrance of all notes in a special journal. 

The investigation and examination is best conducted, from the 
standpoint of light and cleanliness, outside the stable, in which 
case the numerous simple and cheap stocks very common in this 
region serve an excellent purpose. 

Should this be wanting, the cow should be closely secured to a 



operative Handli7ig of Ovarian Cysts 205 

ring in the wall or to a wagon, by means of a strong halter or 
horn rope. The position of the examiner should not be too low, 
and should be clean and dry. Cows which are sensitive about 
the handling of their genitals should be secured so that they can 
not move very freely, by forming a triangle by means of a wall 
with a wagon placed obliquely against it, the cow being tied short 
in the apex of the triangle so that she can neither move forwards 
nor backwards, while lateral movements are controlled by pushing 
the heavy wagon toward the wall and closing the base of the 
triangle. In very cold weather or when flies or gadflies are 
numerous, the animal may be secured and examined in a horse 
-stall. Prior to the examination, the external genitals, anus and 
vagina should be well cleansed by means of a clean handtowel. 

If the right hand is to be used by the examiner, the tail should 
be turned to the right and held by an assistant standing on the 
left side of the cow, and reversely. The proper examination of 
the special genital organs requires a blouse to protect the cloth- 
ing and two, or better three assistants, much patience, at all 
times great cleanliness, removal of all finger rings, thorough 
oiling of the hand and arm, as well as closely trimmed nails. 
The evacuation of the rectum, especially in winter and in ani- 
mals not greatly excited sexually, is most conveniently brought 
about by inserting the fingers, up to the metacarpus, in the anus 
and, spreading the digits apart, permitting air to enter the rectum, 
upon which defecation usually occurs spontaneously ; otherwise 
the rectum needs be evacuated with the hand. A special flush- 
ing out of the rectum with the addition of anaesthetics we deem 
unnecessary. 

In order to avoid as far as possible the troublesome arching of 
the back and pressing upon the rectum, which renders the ex- 
amination and handling difficult and, especially when upon green 
food, becomes very disagreeable, it is recommended to gather the 
skin in folds just behind the withers, to pinch the skin of the 
back between the fingers, to press upon the anterior dorsal region 
by means of a round beam, and to strike .sharply upon the horns 
with a small stick. [A wooden beam 5 to 6 feet long placed 

across the back and borne down by a man on either side, is, in 
our experience, the most effective plan for preventing straining.] 

In locating the ovaries it is to be first remembered that the 
normally involuted, symmetrical, unimpregnated uterus, weigh- 



2o6 Veterinary Obstetrics 

ing 600 to 700 grams, may be grasped in the open hand and car- 
ried relatively far backwards into the pelvic cavity. As a result 
of estrum, the uterus is normally quite hyperaemic for three days, 
abnormally for four to six days, so that it is consequently larger, 
denser and firmer, which condition causes it to be readily felt 
just beneath the rectum. 

It is to be noted that the uterus frequently does not lie 
exactly on the median line but either to the right or left, 
and indeed far more frequently to the right side. The find- 
ing of the ovaries and their identification, which for the be- 
ginner is often very trying and sometimes accompanied by 
errors leading to fatal consequences, requires much training. 
The latter increases, however, the self-confidence in the proper 
examination and handling of the case and renders inner palpa- 
tion, in the course of time, more and more easy, until it finally be- 
comes no longer disagreeable. In case of veterinarians with 
limited experience, the ovary is most safely discovered by first 
grasping the uterus and thence palpating along the uterine cornu 
on the concave side until the apex is reached, from whence, 
slightly laterally, the ovary is loosely attached in the anterior 
border of the broad ligament, where it can be picked up. More 
experienced practitioners search directly for the ovary on the 
anterior border of the broad ligament and draw it backwards. 
In cases of pregnancy or pyometra the ovaries are carried far 
forward and downward into the abdominal cavity and thus render 
it difficult or impossible to reach and detect them. They are also 
frequently difficult to locate and grasp when the animal strains 
violently and the rectal walls are tensely stretched and also 
where the ovary is enclosed within the ovarian sinus, that is 
where we have to do with a so-called encapsulated ovary. In 
such cases it avails nothing, even if theos uteri projects into the 
vagina far enough to be grasped, to draw upon the cervix, 
either with the naked hand or with it wrapped in a small clean 
towel. In case of slight filling of the uterus with pus or other 
liquid, the ovary lying beneath the uterine horn may be made 
accessible by turning the uterus on its long axis or the hand, with 
which the palpation is being made, passed underneath it, but not 
by elevating the abdominal floor by means of a beam. 

The examination of the ovaries includes the size, form, 
character of the surface, consistence of the tissues and presence 



Rupturing of Cysts per Rectum 207 

or absence of pain on manipulation. Normally, ovaries without 
fresh corpora lutea, according to the age of the animal, as already 
related on page 168, are the size of a pea, bean or large hazelnut, 
ovoid and of firm-elastic consistence. I^arge, ripe follicles vary 
in size from a pea to at most the size of a hazelnut and are 
recognizable as soft, elastic, fluctuating spots, slightly elevated 
above the surface. Corpora lutea, when fresh, vary in size from 
a hazelnut to a hickorynut, project beyond the ovarian surface 
as slightly elastic, wart-like outgrowths ; older and partly re- 
sorbed and persistent corpora (corpora albicantia and persisten- 
tia) are only the size of a pea to that of a hazelnut, protrude 
less, and are of a more firm and solid consistence. 

In the handling of ovarian cysts we have for manj' years re- 
lied upon the following methods in this clinic : 

1. The rupture of the cysts by compression per rectum. 

2. The rupture of the cysts \>y compression per vaginam. 

3. The puncture of the cysts through the vaginal roof. 

4. The injection of disinfecting liquids into the ovaries. 

5. Unilateral or bilateral castration. 

I. Rupturing the Cysts per Rectum. 

By this process, which was first described by Zangger, the 
cystic degenerated ovary is grasped through the rectal wall, and 
the cyst ruptured, either by compression with the entire hand or 
by grasping it between the volar surfaces of two fingers and the 
thumb bent at a right angle or by pressing it between the hand 
and the ilial shaft or border. Care is to be taken that the bowel 
contains no feces, and it is to be remembered that the operation 
is more difficult in freshly fed cows on account of the more 
abundant defecation and, therefore, when practicable, should 
be undertaken during the afternoon, which has the further ad- 
vantage that, in case of the advent of fatal hemorrhage, the 
emergency slaughter need not be undertaken until the following 
morning, instead of during the night. In a large proportion of 
cases, moderate pressure suffices to bring about the rupture of the 
cysts, the accomplishment of which is to be recognized by a 
sudden collapse of the ovary in the hand. 

In reference to the possibility of rupturing the cysts, those 
which are solitarj', thin walled and of recent formation are uni- 
formly most certain and easiest. In our experience with many 



2o8 Veterinary Obstetrics 

thousands of cases of cj'stic ovaries, we find the recent and 
easily rupturable ones chiefly in heifers and in cows which have 
recently calved and indeed with equal certainty whether the 
duration of pregnancy has been normal or not. The same is true 
of nj'mphomaniac cows which have onl}' recently become affected, 
and of cases previously treated, in which the cj'sts have recently 
recurred. 

By mere accident apparently, in certain herds in which the 
cows and heifers run at pasture the entire summer and where 
they receive very little artificial food, the cysts are generally thin 
walled and easily ruptured. 

If the peripheral cj'sts be of long standing and possess a thick, 
tough capsule, earnest warning need be given, before the rup- 
ture of the cysts per rectum is undertaken, against the a'ccom-' 
panying dangers of severe maiming or tearing of certain, or of 
all the tissues of the rectal walls. 

It makes a bad showing if — in cases where the operation has 
been very difficult, as for example, where the patient is very 
resistent, shows great uneasiness and strains violentlj^ or 
great sensibility in the ovaries which have alread}^ been sub- 
jected to the crushing of cysts several times, or difficulty in locat- 
ing and grasping them, etc., — the operator withdraws from 
the rectum a bloody hand, since these unfavorable appearances 
do not tend to increase the esteem in which the operation is held, 
nor the standing of the operator. 

In peripheral cj'sts of varying ages, a cyst in one ovary may be 
easily crushed while, in the other gland, one of equal size will 
be very difficult or impossible of rupture. In cases of two or 
more cysts in one ovary, first one cj'st and then the other is felt 
to rupture, after which there is recognizable a minute fragment 
of the ovary, which, however, amply suffices for inducing the 
occurrence of normal estrum, although the remnant consists 
merel3^ of an empty, collapsed capsule; a small, empty, flat bag. 
If, in addition to one or two cysts, a corpus luteum is found, 
the latter usually becomes ruptured or pressed out first and then 
the cysts often burst spontaneouslj' ; however, it sometimes 
occurs, as shown b}^ our collection, that the cysts rupture while 
a small corpus luteum remains intact in the ovary, and for its 
dislodgement a still greater pressure is necessary. 



Rupturing Cysts per Vaginam 209 

2. The Rupture of the Cysts Per Vaginam. 

For a long time we have, in addition to the rupturing of ovar- 
ial cysts per rectum, also practiced rupturing them per vaginam, 
an experience devoid of danger throughout, easily accomplished 
and accompanied by excellent results. 

The operation per vaginam is to be recommended in all those 
cases where ovarial cysts cannot be easily and safely ruptured 
per rectum. In this regard it is to be preferred in all those cases 
of peripheral cysts with thick walls, such as usually form in 
dumb bullers, "stillochsigkeitt," and also in old, recurrent, 
thick- walled cysts, as well as in multiple and central cysts. L,ike- 
wise, it constitutes an excellent method for dislodging very firmly 
embedded hypertrophied corpora lutea which require removal. 

The operation is uniformly possible in cows of the spotted and 
brown breeds so long as the vulva and vagina are free from 
strictures and also in large two-year-old heifers with sound vag- 
inae it succeeds almost without exception if certain precautions 
are observed. Palpation per vaginam is difiicult or impossible 
in heifers with fresh vaginitis follicidaris in/ectiosa, in heifers 
and cows which have been handled for this disease with power- 
fully irritant or caustic remedies ; also in animals with strictures 
or adhesions of the vagina, to which there is almost uniformly a 
well marked tendency after vaginal injections of a 2% pyoktanin 
solution in a vagina affected with infectious nodular disease ; and 
finally in two or three-year-old animals which have aborted dur- 
ing the first half of pregnancy or have suffered from placental 
retention and whose vaginse have been irritated and lacerated by 
palpations by inexperienced and incompetent persons. 

Besides the customary precautions, palpation of the genital 
organs demands a thorough oiling of the vulva and the hand. 
The hand, usually the right, which is naturally the stronger, is 
then gently pushed through the vulva with a rotary motion 
until it reaches the os uteri externum. After the right hand has 
been successfully introduced, the left can then readily be in- 
serted without special difficulty. After completing the examina- 
tion of the vagina, the manual displacement of the ovary is car- 
ried out. Following the grasping of the cyst per rectum it is 
then pushed backwards with the right hand and held down- 
14 



2JO Veterinary Obstetrics 

wards. First the diseased ovary is firmly grasped and drawn as 
far backwards as possible. The left hand, carefully prepared, is 
then inserted with the greatest caution into the vagina and the 
ovary, now held in the right hand per rectum, is grasped firmly 
with the left through the roof of the vagina. 

Should the ovary escape because of sudden straining, search 
for and grasp it again with the right hand, per rectum, for which 
purpose it is best to partly withdraw the*left until the gland is 
again located and secured. By lifting and pushing the rectum 
aside, the ovary is freed from the bowel and lies now surrounded 
•only by the superior vaginal wall. Grasping the gland, either 
between the thumb, index and middle finger, or in the entire left 
hand, it may then be pressed and ruptured with all the force at 
command without any important injury to the vagina. In one 
exceptional instance, indeed, in a case of sclerotic ovary, the 
albuginea was ruptured, which was followed by no ill conse- 
quence. Should the left hand for anj^ reason whatever become 
exhausted, it should be withdrawn and the right used in its 
stead. 

The bursting of thick-walled, large cysts is recognizable by 
the sudden disappearance of resistance and is now and then evi- 
denced by a slight cracking sound. It is highly advantageous 
that the rectal .straining generall)' exerts no, or in other ca.ses, 
only very slight influence upon the fixation of the ovary per 
vaginani, as a consequence of which the final compression is 
very much easier and more possible than by fixation of the ovary 
through the rectum. The thinner and more flaccid the superior 
vaginal wall and the farther the ovary can be drawn backwards, 
the easier the operation, and vice versa 

We have attempted to rupture central cysts through the supe- 
rior vaginal walls by a specially constructed instrument similar 
to the lithotrite of Weiss, but without result, as it was impossible 
to secure the affected ovary through the superior vaginal wall 
even though ample and flaccid. 

In cows with large, wide, relaxed vaginae we have also at- 
tempted to secure the ovary through the superior vaginal wall by 
means of an ecraseur chain and then to rupture or puncture the 
cysts, but we have found it a very exhausting task, which rarely 
succeeds, and our experience has not warranted recommending it. 

In cystic degeneration with adhesions of the ovaries to neigh- 



Puncturing Cysts through the Vaginal Wall 211 

boring parts so that they cannot be pushed backwards per rectum, 
as well as in cases of abscess of the ovary, it is good policy to 
abandon manual handling and, instead, to castrate the animal by 
intra-abdominal ligation. And, finally, in cases of encapsulated 
ovaries which cannot be detached and which resist attempts to 
rupture them in their sinuses, there only remains castration with 
ligation of the ligamentary apparatus. 

3. The Puncture of the Cysts Through the 
Superior Vaginal Wall. 

This operation is indicated in cases of very thick-walled pe- 
ripheral or central cysts which cannot be. ruptured per vaginam. 

It maj' be carried out with a very small concealed bistoury or 
with equal facility bj' means of the 5.5 cm. long intestinal trocar 
without canula such as we have used for some years and is made 
by Hauptner in Berlin. The strictest possible antisepsis of the 
external genitals, of the hand introduced into the vagina and 
disinfection of the instruments, is essential. The operation is 
simple and is not followed by important sequelae. The affected 
ovary is grasped and fixed with the right hand per rectum while 
the instrument, carried into the vagina with the left, is passed 
through the superior vaginal wall into the cysts. 

The puncture of the cyst causes a disappearance of resistance 
and by light pressure complete evacuation is readily induced. 
The ovary then consists essentially of an empty capsule. If the 
first effort is unsuccessful, draw the trocar back into the vagina 
somewhat and insert it at a different point in the ovary. 

In this operation, owing to the fact that the ovary is fixed 
b}' the hand in the rectum, it occasionally happens that the 
intestinal wall is wounded, but this is of no consequence since 
the muscles, being both circular and longitudinal, promptly 
close the small wound and prevent any escape of contents. This 
occurrence may be avoided in old cows with roomy vaginae by 
grasping the ovary through the vaginal walls with the left hand 
and holding it far backwards, and then passing the right hand, 
armed with the instrument, alongside the left and making the 
puncture with entire safety. 

When the ovary can be drawn far backwards we have been 
enabled to make the puncture with the intestinal trocar by 



212 Veterinary Obstetrics 

merely inserting the fingers of the right hand into the vestibule 
of the vagina. 

4. Injection of Disinfectants into the Ovaries. 

Quite analogous to emptying the ovarian cysts by puncture is 
the injection of them with disinfecting ;and dispersing agents. 
This was first recommended by Bertschy (Schweitzer- Archiv. 
1906, p. 155) in cases of cystic ovaries, especially those under- 
going fibro-cystic degeneration or containing central cysts. We 
use for this purpose a Dieulofoy syringe fitted with a special 
rubber tube from the syringe to the canula, through which we 
inject a 1:10 Tr. Iodine solution. 

The practical results of puncture of cystic degenerated ovaries, 
as well as the intra-ovarian injections, according to our statistics, 
are evident only in rare cases, a fact which supports our teach- 
ing throughout that, when C3'stic ovaries cannot be restored to 
their normal condition and function by rupturing the cysts by 
compression, either through the rectum or vagina, the last and 
only rational resort is the uni- or bilateral castration of the 
animal. 

When the cysts are successfully evacuated earlj^, there is re- 
covery from the nymphomania in from two to. eight days. First 
the sexual excitement abates ; the animal becomes more quiet in 
from 12 to 24 hours, more docile and can again be turned with 
the other cows to water or pasture. The sunken sacro-sciatic lig- 
aments become normal, the vulva smaller and firmer, the vulvar 
opening and vagina narrower and the vaginal entropium ceases. 
Because of the contraction of the uterus and closure of the cervical 
canal, the slimy mucous discharge ceases. The heretofore wild 
expression of the eyes becomes again normal and docile, and in 
a short time there is distinct improvement in the body nutrition, 
besides a qualitative and quantitative improvement in the milk 
secretion, changes which clearly increase the worth of the patient. 
Within about twenty days after the operation another notable 
result appears — the disappearance of the pi-olapsus vagince, or pro- 
lapstts portio7iis vagiiialis uteri. It is to be observed in reference 
to the latter that the recovery occurs without vulvar sutures and 
without the notable vulvar cicitrization, which decreases the value 
of the animal. Only in old cases with debility are vulvar sutures 
demanded. Furthermore, in about three weeks the normal estrum 



Sequela of Crushing the Ovaries. 213 

appears, when it is advisable to allow the animal to be bred. The 
custom, in some regions, of causing the cow to be served immedi- 
ately after the operation is not favorable to conception according 
to our observation and raises the question whether this premature 
copulation and excitation of the genital system does not really 
do harm and tend to cause the recurrence of the cystic degener- 
ation. Especiallj' in well nourished heifers and in deep milking 
adult cows, ovarian cysts sometimes recur again and again so 
that they may be ruptured three to fifteen times, which puts a 
heavy tax on the time and energy of the veterinarian. 

It is interesting to note that exceptionally in cases of dumb 
estrum, after the cysts have been ruptured, normal estrum fol- 
lows or erethetic nymphomania with a recurrence of the cysts. 
Further, in rare cases, thick walled cysts, present at a first exam- 
ination and impossible of rupture, are readily ruptured under mod- 
erate pressure two or three weeks later. 

We have also noted rarely that fibrous degenerated ovaries, 
after vigorous vaginal pressure and massage, sometimes develop, 
in the course of fourteen days, cysts as large as small hen's eggs. 

In general the rupture of ovarial cysts, when carefully under- 
taken, is easy of accomplishment and without danger, and onlj' 
requires after attention in the exceptional cases already men- 
tioned. Serious or fatal sequelae have not followed the rupture 
■of ovarian cysts or the dislodgement of persistent or hypertro- 
phied corpora lutea in this ambulatory clinic in spite of the many 
thousands of cases operated upon, but we have had the fortune 
to observe such accidents elsewhere. 

Among the sequelae we may mention : 

A. Great Hyperesthesia of the Rectum and 
Genital Organs. 

Now and then one meets with a cow which has been rudely pal- 
pated per rectum several times by an inexperienced person ; or 
affected with a chronic intestinal catarrh or intestinal tubercu- 
losis ; adhe.sions of the uterine cornua and ovaries to the sur- 
rounding organs ; abscesses in the ovarian ligament ; or, from 
iandling for granular venereal disease, has become uncommonly 
sensitive and strains violently, accompanied by the inspiration of 
air into the rectum. The straining rnay be somewhat controlled 
by pinching or nipping the dorsal spine for 30 to 60 minutes, 



214 Veterinaiy Obstetrics 

while the inspiration of air into the rectum may be obviated by 
pressure on the anus or, still better, by covering the anal opening 
with a folded hand-towel. 

Heifers and cows which have been previously handled for in- 
fectious granular venereal disease, with irritant remedies, or are 
still suffering from the malady, are frequently so irritable and 
afraid of the handling of the vulva or vagina that they are very 
resistent and requite very careful and close securing and, even in 
the stocks, may either lower the hind quarters, rear, or throw 
themselves down and thus render the examination very difficult. 
As a general rule the hyperesthesia of the rectum and vagina 
disappears spontaneously after eight to ten weeks. 

B. Kinking of the Lumbo-Sacral Symphysis. 

By this term we understand a sudden and rapidly alternating 
elevation and depression of the lumbo-sacral articulation, with a 
cracking sound. It occurs in young, timid animals and now and 
then also in animals suffering from a serous infiltration of the 
superior vaginal wall. As soon as, or just after, the hand is 
passed into the rectum or vagina there occurs a sudden elevation 
and depression of the S3mphysis, which painfully injures the 
operator's arm and causes him to let go the ovarj', which has 
already been grasped. This very anno5'ing symptom usually 
ceases spontaneously in a few minutes but disappears more 
promptly by tapping the horns, pres.sing upon the back and 
leaving the arm wholly passive in the rectum. 

C. Serous Infiltration of the Superior Wall 
OF THE Vagina. 

This condition is rarelj' seen except as the consequence of re- 
peated rude palpation of the vagina or as a result of the injec- 
tion of irritant remedies, especially in the treatment of granular 
venereal disease. As a result the vagina becomes as much as 5 
cm. thick with extensive serous infiltration, is sensitive, and the 
folds are obliterated so that grasping of the ovarj' through the 
vaginal wall is exceedingly difficult, if not impossible. 

By suspending the vaginal palpation, recovery occurs sponta- 
neously in 4-6 weeks. 

D. The Detachment of the Ovary. 
In the operation of securing the ovary per rectum preparatorj^ 



Sequela of Crushmg the Ovaries. 215 

to rupturing cysts or detaching persistent hypertrophied corpora 
lutea, it has happened to us in four cases in high bred, excitable 
heifers and young cows (never in adults), owing to sudden 
straining or the sudden dropping of the lumbo-sacral articulation, 
that the grasped ovary, attached to the fine, tense ligament, is 
unexpectedly torn away from its attachments and remains in the 
hand, to later fall into the abdominal cavity. The same misfor- 
tune can occur by drawing the ovary too far backward when 
grasped /ifr rectum or vaginam. In all such cases, the ligament- 
ous apparatus should be immediately and carefully examined in 
order that hemorrhage, if present, may be controlled by compres- 
sion. In two of these cases we clearly felt per rectum the pulsa- 
ting, bleeding ovarian artery, which we compressed, as well as 
possible, for twenty minutes. Of the ft>ur cases, one failed to 
again show estrum, but the other three all conceived. 

It is well to bear in mind that, after the total ablation of an 
ovary, as also after the pressing out of large, fresh corpora lutea 
and vigorous after-compression of the ovary, the animal now and 
then shows, for 30-60 minutes, slight colic symptoms (castration 
colic), such as uneasiness, suspension of feeding, elevation of the 
tail without tympany, which symptoms .spontaneously disappear 
in a short time. 

F. Laceration of the Rectum. 

This accident occurs mostly in delicately built heifers with a 
narrow rectum, or in good milch cows in which the rectum pos- 
sesses very slight resistant power and, even by very slight pres- 
sure, is lacerated. These rather frequent lacerations, due con- 
stantly to improper palpation, maj' involve only the mucosa or 
include the muscular, and even the serous coats. 

While scratches and lacerations in the mucosa of the pelvic 
portion of the rectum from too long finger nails is as a rule 
inconsequential, extensive lacerations of the mucosa and muscu- 
laris lead readily to rectal strictures and to adhesions of the rectum 
to the surrounding parts. Small penetrant wounds in the pelvic 
rectum, which quickly close, lead to extensive suppuration or 
septic phlegmon in the peri-rectal or peri-vaginal connective 
tissue and thereby cause compression of the rectum with long 
continued straining and pressure upon the feces, marked narrow- 
ing of the rectum and vagina, adhesions of the rectum to its sur- 



2i6 Veteri7ia7y Obstetrics 

roundings, slight pj'aemic fever, emaciation, lumbar weakness 
and septicaemia. Now and then the abscesses break into the 
vagina, following which complete recovery may occur. Severe 
penetrant wounds of the rectum lead to fatal hemorrhage or 
septic peritonitis. 

G. Fatal Hemorrhage From the Ovarian Artery. 

(^Heinorrhagia artericB ovaricce. ) 

The most to be dreaded and certainly also more common sequel 
of ovarian operations than generally believed, is the slow bleed- 
ing to death from the ovarian arteries. Because of the non- 
vascularity of the capsule in peripheral ovarian cysts, hemorrhage 
does not occur from them, but serious or fatal hemorrhage is at 
times observed after the dislodgement of corpora lutea by com- 
pression, after severe crushing and laceration of the ovaries, and 
is possible also after the inadvertent tearing away of the ovary 
from its attachments. In ovaries affected with angioma and 
blood cysts, fatal hemorrhage may readily be caused. 

In the last case, which is very rare, the ovary feels soft, elastic, 
flabby, spheroidal, varies in size from that of a man's fist to a 
child's head and, in case of an angiom, possesses a spherical or 
slightly nodular character. Upon pressure, the angiom dimin- 
ishes in size but when the compression is removed the refilling of 
blood soon restores it to its former dimensions. We have twice 
had the opportunity of observing cows in which ovarian angioma 
had been lacerated through improper handling, followed by severe, 
though not fatal, intra-abdominal hemorrhage. 

The symptoms which serve to indicate ovarian hemorrhage 
and which appear a few hours after the operation are as follows : 
decreased or wholly suspended appetite, fullness in the upper 
flank, weariness, weakness, quickening of the respiration, violent 
heart beat, feeble pulse, muscular tremblings, cold horns, ears 
and feet, anaemia of the visible mucosa and the skin of the udder. 
Death usuall)^ follows 15-36 hours after operation. 

Aside from these fatal hemorrhages, others of a less serious 
character occur and become spontaneously stopped. The condi- 
tion may cause a more or less complete loss of appetite and rumin- 
nation for one or two meals and a varying degree of fullness in 
the upper flank region. After 24-96 hours the animals recover 



Seqiceltz of Crushing' the Ovaries. 217 

their normal health. Evidently, fatal hemorrhage may also ac- 
company more or less extensive lacerations of the rectum. 

In one cow we ruptured by compression on two occasions, 
April and August, 1906, what we believed to be thick-walled ab- 
scesses the size of a hen's egg in the right ovary, which was fol- 
lowed in each case 24 hours after operation by symptoms of se- 
vere peritonitis, which persisted for 14 days, so that our view 
was supported that in this case we were not dealing with a cyst, 
but with an ovarian abscess. 

With a view to prophylaxis of fatal hemorrhage, we believe the 
chief danger lies in too hasty, too careless operations, and in 
a too loose generalization of cases. If, therefore, each case is 
judiciously considered separately, as is undeniably demanded, 
there is no fear of after-hemorrhage. The careful, experienced 
practitioner will lind cases of diseased ovaries which it is injudi- 
cious to handle. 

From a prophylactic standpoint, it is desirable, in all those cases 
where it is not perfectly certain that it is a cyst which is being 
ruptured, that digital compression should be applied to the ovary 
for 10 to 20 minutes after the operation, or, this being impractic- 
able, the compression may be applied per rectum or per vaginam 
to the ovarian artery, which lies just beyond the apex of the 
uterine cornua. While the after-compression carried out per 
rectum has the disadvantage of being rendered difficult by the 
straining, and is more certain, reliable and easier per vaginam, 
either is efficient and trustworthy. In addition, the owner or 
milker should keep the patient under observation, whether day 
or night, for some fifteen hours after operation. 



5. CASTRATION 

This final therapeutic agency, the last resort, the indications 
for which have become constantly more precise during recent 
years, and the worth of which in certain cases is unquestioned, 
is also to be considered here. 

The reasons for castration, as revealed by our numerous obser- 
vations, are as follows : — 

a. Recurrent peripheral cyst-formation in one or both ovaries, 
accompanied by nymphomania, when, in spite of frequently re- 
peated rupturing of the cysts, a restoration to the normal condi- 
tion cannot be effected. These conditions apply especially to 
aged cows yielding more than three liters of milk per milking, in 
which, in spite of repeated rupturing of cvsts, a slight sexual ir- 
ritation, such as a slight falling in of the broad ligaments of 
the pelvis and swollen vulva, persist. On the other hand, we 
have not castrated any young breeding cows for years, because 
of peripheral cysts, until after we had ruptured the cysts 6-8 
times in an attempt to bring about recover}', and in several cases 
it was not until after the cysts had been ruptured 8-i2 times that 
normal estrum and pregnancy resulted. 

b. Central or multiple cysts which cannot be broken by com- 
pression nor evacuated bj' puncture. 

c. Finally, ovarian edema and ovarian abscesses. 
The operation is contraindicated : 

a. In dumb estrum, loss of estrum due to atrophy and sclero- 
sis of the ovary ; 

b. In ovarial tuberculosis ; 

c. In cancer of the ovarj' ; 

d. In nymphomania dependent upon disease of the oviducts, 
the ovarian ligaments, the uterus or the vagina, such as serous 
salpingitis, cystic formation in the ligamentous apparatus of the 
ovary, tuberculosis and cancer of the uterus and vaginal polypus. 

e. In tuberculous, poor, cachectic animals. 

f. In cows with too narrow vaginse due to vaginal stricture.* 

[*The author apparently has in mind only the vaginal ovariotomy which 
the pathologic condition prevents, but which could not influence the flank 
operation. ] 
2l8 



Castration 2ig 

From the foregoing it will be seen that the indications for 
castration have been reduced to a more limited compass than 
during earlier j^ears, and there can be scant objection thereto 
because of the present enormously high price of breeding cattle, 
so that it becomes one of the greatest duties of the practicing 
veterinarian to resort to every possible means to preserve to the 
utmost the breeding power of well bred and valuable animals. 

We hold therefore that the wholesale castration of nympho- 
maniac cows without first resorting to earnest attempts at curing, 
the malady, robs them of their parturient function in a manner 
contrary to the interests of science, veterinary practice and stock- 
breeding. 

According to veterinary authors cows rgay be castrated by : 

a. The flank incision ; 

b. The vaginal incision ; 

c. Ligation of the ovar}- through the inferior rectal wall (Ex- 
perience of Trachsler-Berdes, Koch's Encyclopaedia der gesamm- 
tenThierheilkunde und Tierzucht). 

For a number of years we have endeavored to perfect the 
method of castrating cows. We have made the following in- 
vestigations upon cows designed for slaughter : 

a. Castration by tearing the ovaries from their attachments. 
In heifers with thin, weak ligaments the detachment of the 
ovaries per rectum or vaginam is comparatively easily and 
quickly effected, while in old animals with strong broad liga- 
ments the operation becomes impossible even per vaginam. 
The character of the lesion after division by tearing the ovary 
away in young animals is analogous to that induced by the 
ecraseur, while, in old cows, the ligamentous apparatus of the 
ovary tears very irregularly and sometimes involves the uterine 
cornua. 

The danger from fatal hemorrhage may be excluded by after 
compression, the artery being compressed between the thumb 
and fingers for a few minutes, but in one case we observed in 
the abdomen, one hour after castration, about one liter of blood. 
We have further found that the power of ovarial regeneration 
in the heifer is astonishing and that if a fragment of ovarian 
tissue as large as a pea or even a pinhead is left on the ligament 
it may rapidh' develop and within 9-10 daj's contain one or two 
large corpora lutea or a cyst. [Upon the western plains of 



220 Veterinary Obstetrics 

America where removal of the ovaries by Hnear tension or tear- 
ing away is practiced in the spaying of heifers for fattening, 
estrum and nymphomania are reported common, surely as a 
result of leaving behind some vestiges of ovarian tissues.] 

b. Castration by torsion of the ovarj' from the rectum or 
vagina. While, in the cadaver, the detachment of the ovary bj' 
torsion requires 6-10 complete revolutions, we failed in every 
case to bring about its removal by this means in the living 
animal because of the firmness of its attachment to the broad 
ligament and the smoothness of the ovary, which caused it to 
inevitabl}' slip away. 

c. Equally impracticable to the two preceding methods have 
proven our attempts to ligate the ovary through the superior 
vaginal wall, including the latter with strong silk or elastic liga- 
ture, which was attempted by us in old cows with wide, flaccid 
vaginae. Apparently our failure was due to the violent strain- 
ing following the operation. 

d. On the other hand, the method of castration which we have 
regularly applied in our work and which has yielded excellent 
results is based upon the modern surgical principle that only the 
diseased part is to be removed, so that for some years we have 
practiced unilateral castration bv vaginal incision. 

This operation is indicated in valuable pedigreed animals with 
only one ovary involved in cystic degeneration, of a character 
which can not be removed b}' manipulation and which is causing 
nymphomania or sterility. Its success depends upon the sound- 
ness of the remaining ovary, which can be readily verified by 
direct palpation through the vaginal opening during the opera- 
tion. The practical results of this operation, showing its great 
economic value, we are able to show from our experience that, if 
the remaining ovarj- is wholly normal, estrum ensues in three 
weeks after castration and that, after another three weeks, the ani- 
mal can be successfully served and impregnated. On the other hand 
we freely confess that the one sided castration, by increasing the 
nutritive supply to the remaining sound ovary, may lead to its 
cystic degeneration, and that experimentally we may cause the 
development of cysts by unilateral castration. If the remaining 
ovary is only slightly enlarged, the increased nutritive supply to 
it resulting from the removal of the diseased organ causes the 
Tegular occurrence of peripheral cysts in from 2-4 weeks after 



Castration 221 

the operation. The repeated rupture of these by compression 
is indicated, but the constant tendency is toward an eventual 
sclerosis of the organ. More seldom the operation is followed at 
first by an exaggerated estrum with a large corpus luteumand, 
after its dislodgement by compression, solitar}' or multiple 
peripheral cysts appear and the ovary becomes sclerotic. Should 
the changes in the ovary seem incurable and be accompanied 
by nymphomania, the castration needs be completed. 

In a very valuable Simmerthal cow which had been under 
treatment for n3'niphomania for nine months, we found the left 
ovary the size of a hen's egg and affected with multiple cysts. 
The right ovary was divided into two spherical parts, which were 
separated about 4 cm. from each other and possessed a dumb-bell 
form in miniature. In this patient the left ovary was completely 
removed with an emasculator and, from the right organ, only one 
of the two spherical masses was removed with the chain ecraseur. 
Examination of this mass showed it to be a large, round, firm cor- 
pus luteum permeated by connective tissue. Ten days later the cow 
showed nymphomania, from a cyst formed in the right ovary, 
and eight weeks later it became necessary to completely remove 
the remainder of the right ovary because of extensive cj'stic 
disease after the cysts had been ruptured eight times in vain. 

e. The results of complete castration are similar in many respects 
to the successful handling by rupture of the cysts. The animals 
become quiet, sexual excitement disappears completely and the sa- 
cro-sciatic ligaments resume their normal position. As a result of 
the decreased vascularitj^ the uterus, vagina and vulva become 
distinctly smaller, prolapsus vagince or prolapsus uteri portio vagi7i- 
a/zj- disappears and nutrition is increased, that is, the animal is more 
readily fatted and, while the animal yielded but about three liters 
of milk per milking before castration, by inhibiting the sexual 
functions and reflexes, the milk is materially increased in quan- 
tity and the ' ' holding up " of the milk is stopped. The influence 
of castration upon the course of tuberculosis — whether it amelio- 
rates the disease and tends to cure it or not and what general 
influence it exerts upon soundness and vigor, as indicated by 
cardiac and muscular power — it would be interesting to determine 
by further experiment. 



The sequelse of castration as observed by us in the course of 



222 Veterinary Obstefi'tcs 

years are by no means of so harmless a nature as many would 
have us believe and there is good room for differences of opinion 
as to its value in many cases. Among these unfavorable results 
are to be counted severe or fatal hemorrhage, in connection with 
which it might be urged that, in the castration of cows, the most 
rigid antiseptic precautions should be observed and that the pre- 
vention of even the slightest hemorrhage from the ovarial arteries 
is of very great importance in relation to infection, because any 
hemorrhage, with the resultant formation of hematoma or blood 
coagula, tends to favor the development of severe complications, 
the blood clots serving as a culture medium for bacterial growth. 

Hemorrhage from the ovarian artery also tends to induce 
ichorous-purulent and sero-fibrous peritonitis, indigestion and 
gastric catarrh, accompanied often by a permanent reduction 
of the milk secretion ; also serious phlegmon in the periproctal 
-vaginal and -vesicular connective tissue, complicated bj' difficult 
urination ; abscessation in the stump of the ovarian ligament, with 
or without rupture into the rectum ; pelvic abscess, with rupture 
into the vagina or later into the peritoneal cavity ; encapsulated 
intra-peritoneal abscesses, leading to great emaciation ; cysts 
as large as the fist forming in an ovarian ligament, leading to 
emaciation ; as well as incomplete removal of the ovary, leading 
to the recurrence of cysts and nymphomania. 

Young and old castrated cows in a moderate or good state of 
nutrition, according to our observations, fatten well; but when 
slaughtered the flesh is 3'ellowish, spongy, coarse-grained and 
not to be called prime in qualitj', for which cause in this region 
old, fat castrated cows are not sought after as first-class butchers' 
stock. It is, however, to be remarked, as we have frequently 
observed, that thin, castrated cows are largely sold fraudulently 
as dry, farrow animals. 

II. COLIvRCTIONS OF PuS IN THE UTERUS. 
Pyometra. Hydro7netra. 

Bj- pyometra or hydrometra we understand the collection of a 
varying amount of pus or muco-purulent, (pyometra) or .sero- 
mucoid fluid (hydrometra) in the uterus. This is comparatively 
common in the cow, more rare in the goat, and is accompanied 
or succeeded by various diseases of the genital organs It oc- 



Pyometra. 223 

curs chiefly in 4-8 year-old cows, mostly in breeding and good 
milking cows, seldom in farrow animals. It is largely caused 
by abortion, premature birth, retained placenta, catarrhal or 
purulent eudo-metritis, maceration of the fetus and, according to 
our observations, very often by the infectious granular venereal 
disease. 

Although the symptoms vary somewhat they show a notable 
constancy. 

First of all, contrary to our literature on the subject, our 
numerous clinical records teach that cows with abnormal col- 
lections in the uterus do not longer come in estrum, which con- 
dition, in ca.ses where the pyometra had been preceded by e,strum 
and coition, very often leads to the false assutnptio7i of pregnancy. 
Furthermore, the condition of the broad ligaments of the pelvis, 
the size of the vulva, the extent of the vulvar and vaginal canal, 
are ordinarily normal or but slightly altered, and only very .sel- 
dom is there a marked sinking of the sacro-sciatic ligaments. 
Vaginal discharge is frequently ab.sent in .spite of the fact that the 
uterus is greatly di.stended and the cervix uteri is open sufficiently 
to permit the pa.ssage of a pencil, the little, or even the index, 
finger. Now and then there is .seen in the .stall, especially in 
the morning, a mucous, muco-purulent or flocculent purulent 
vaginal discharge behind the recumbent animal. This may be 
temporary or constant and variable in amount. It is also ob- 
served that the opening of the uterine cervix sufficiently for the 
passage of a pencil or of the little finger, and especially the 
vaginal discharge, tends to recur about every three weeks and 
persist for 2-3 days, or after about the same interval of time that 
estrum should normally recur and enduring for about the length 
of time that estrum should continue. In connection with 
the open cervical canal, the cervix and uterus are .slightly en- 
larged or increased to the dimen.sions of a man's arm. The en- 
larged, painle.ss uterus, which is not to be confu.sed with preg- 
nancy, is either symmetric or now and then asymmetric, the one 
horn, most generally the right, being somewhat more distended. 

The size of the diseased horns varies between three and .six 
inches in diameter and naturally their length and thickness vary 
greatly. If each horn does not contain to exceed a few liters of 
contents the point of bifurcation of the horns is very evident as 
is al.so the arching and curvature ; one may also grasp the 



224 Veterinary Obstetrics 

curvature of the uterus per rectum and draw the former back- 
wards and, what is of still greater practical value, may rotate 
the uterus 90° or % revolution on its long axis, by which means 
the ovaries may be grasped and examined. Every collection 
in the uterus causes a displacement in the ovaries, they being 
drawn downward, forward and toward the median line, beneath 
the distended uterine cornu, so that finding and recognizing them, 
especially in cows which strain hard, is rendered very difficult, 
and in the presence of great filling of both horns becomes wholly 
impossible. 

The uterine horns are smooth and of varying degrees of dis- 
tension, at one time being relaxed and flat, at others more 
tense, rounded and sugillating. The contents consist of a 
thin or thick liquid, which is white, whitish-graj' or grayish- 
yellow; either sero-mucous (myxometra) , or, more often, purulent 
or muco-purulent, odorless or fetid (p3'ometra). According to 
its etiology, one may find fragments of fetal envelops, a macerated 
fetus or individual bones, which latter one may distinguish by 
careful palpation. 

The ovaries are usually normal and there is found, what should 
not be underrated from a therapeutic standpoint, in one of them, 
one, two or three various sized persistent corpora lutea firmly 
imbedded in the organ, their presence depending upon the failure 
of their physiologic atrophj' to take place. The other ovary has 
undergone fibrous or cystic degeneration and is from the size of a 
hickory nut to that of a hen's egg. 

Therapeiitics of Pyometra. 

At variance with the general practice and the teachings of ob- 
stetric authors concerning the handling of pathologic collections 
in the distended uterus, we have for years followed a course of 
treatment which has yielded good results in 50 % of all our cases 
and has been accepted bj' many of our colleagues as a reliable 
method. 

Each practitioner well knows that the therapy proposed in our 
literature for this di.sease, the prognosis of which is often unfa- 
vorable, consisting of the injection of astringent and antiseptic 
agents into the diseased uterus, has a higher theoretic than prac- 
tical value because, with the closed or but slightly opened os 
uteri, the sufficient dil&tion of the cervical canal and the subse- 



Pyometra 225 

queut introduction through it into the uterus of the douching 
tube, is accompanied by enormous difficulty and great loss of 
time. 

The therapeutics of the malady is not faciliated, either, by the 
fact that, after the completion of the first dilation, there follows 
several hours of severe straining and pressing, with loss of appe- 
tite, which leads the owner to become dissatisfied and desist from 
further treatment. 

With a view to facilitating the dilation of the cervical canal 
and rendering it easy, as well as avoiding the afterstraining, irri- 
gation of the vagina with water warmed to 39 ° C. is recom- 
mended before and during the mechanical operation. The evac- 
uation of the pus is brought about by depressing the funnel 
attached to the end of the rubber tubing, which acts as a siphon. 
Now and then, though very rarely, one evacuation followed 
by flushing with lukewarm water suffices to bring about recovery 
and cause the recurrence of estrum. 

The treatment employed by us consists of the pressing out of 
the corpora lutea and the per rectum stroking or massage of the 
uterus from before to behind. As already related, the elimina- 
tion of the yellow body is only practicable when the uterus con- 
tains only a few liters of pus, that is, so long as the ovaries can 
be grasped and fixed per rectum. The detachment of the yellow 
bodies is brought about by compression through the rectum or 
vagina. The ovary is grasped between the volar surfaces of the 
thumb and two fingers or between the thumb, index and middle 
fingers and thus compressed. In old standing cases of pyometra — 
when the animal is irritable and strains violently, the rectum is 
very tense, and the corpora lutea are not very large or prominent 
and are solidly bound by connective tissue, that is, almost com- 
pletely encapsulated — the operation becomes very difficult, in 
which case it is our practice to not press out the yellow bodies, 
but to vigorously massage and rub the ovary between the fingers. 
If a voluminous collection exists in the uterus and, in spite of 
drawing it backwards, the ovaries cannot be brought in reach, 
the cow should be at once fed for early slaughter. 

After dislodgement of the corpus luteum, contraction of the 
uterus follows, the os uteri opens from before backward and the 
uterine contents are evacuated ; in approximately 18-72 hours 
15 



226 \'eteri7iary Obstetrics 

after the operation there is observed, especially when the animal 
is recumbent, an astonishingly abundant, purulent vaginal dis- 
charge. It should be seen that this drains away promptly and that 
the floor, where the cow lies, and the gutter are well disinfected. 
As soon as the discharge ceases, which is usually after a very 
brief time, the utefus is small and empty and estrum often appears 
as early as the 4th day, still more commonly between the 4th and 
loth days, after the dislodgement of the yellow bodies, and 
tends afterwards to recur regularly. Upon the second return of 
estrum it is advisable to permit her to be served and conception 
usually follows. 

Exceptions to the type of cases described are seen in those cases 
in which, after the dislodgement of the corpora lutea, the patient 
shows pain, evidently the result of uterine contractions, and, for 
the first six hours after the operation, shows loss of appetite and 
slight tympany. With the advent of the vaginal discharge, 
the.se symptoms promptly disappear. In more tardy contraction 
of the uterus the profuse vaginal discharge extends beyond a 
week and, in the place of the dislodged yellow body, a second 
fresh one as large as a hickorynut develops which, in the interest 
of the evacuation of the uterus, is again to be eliminated and 
indeed this operation should be repeated as long as is needful and 
until the volume of the uterus returns to, and remains, normal. 

In other cases, as a consequence of the prolonged treatment 
with repeated massage of the ovaries and uterus, pain and 
chronic purulent endometritis (whites) are shown by the patient, 
accompanied by slight emaciation. Nevertheless normal estrum 
eventually appears and conception takes place. 

In one cow with recurrent pj'ometra and dense ovaries with- 
out yellow bodies, we crushed the right ovary per vaginam, upon 
which, after iS hours, a complete evacuation of the uterus oc- 
curred and, after 8 days, normal estrum followed. 

Besides the dislodgement of corpora lutea, the kneading and 
massage of the ovaries and the gentle pressure and stroking of 
the uterus, I have, upon the advice of my colleague, Anderegg, 
in Meringen, administered internally for pyometra, bicarbonate 
of soda in doses of 150-200 grammes a day as an emmenagogue. 
The results from this plan were indeed superior to the irriga- 
tions but not so prompt as by operative interference. After a 
few days our cows showed a profuse vaginal discharge and evi- 



Dislodgtne?tt of the Corpus Luteutn 227 

dent decrease in the size of the uterus. Recovery or the recur- 
rence of estrum occurred in one cow 4 weeks after the com- 
mencement of the treatment. 

When symptoms of soda poisoning appears such as weakness 
and diarrhose, the administration of the sodium bicarbonate must 
be suspended for a few days. 

III. The Dislodgment of the Corpus Luteum. 

According to our observations, extending over many years and 
including a large number of cases, we have reached the conclu- 
sion that this operation has not yet received the deserved atten- 
tion. When carefully carried out it is not dangerous, causes 
little pain and the succeeding straining rapidly disappears. 
Aiside from the fact that the elimination of the yellow bodies by 
inducing an active hyperaemia of the uterus, which awakens its 
contraction and increases the auto-antiseptic power of the geni- 
tal canal when affected with pyometra and thus serves a funda- 
mentall}^ useful purpose in this direction, we have also been led 
to apply this new therapeutic measure to other cases with now 
and then good results. 

It has proven useful in chronic purulent and catarrhal en- 
dometritis when combined with massage of the uterus, provided 
that the condition was not dependent partly upon tuberculosis 
or malignant neoplasms. 

It has also proven valuable in the induction of artificial abor- 
tion in young heifers which have been impregnated too early, and 
in cows with large callus formation in the pelvis which would 
prevent parturition ■ at full term. The expulsion of the fetus 
accompanied by the membranes follows in from 24-72 hours 
after the operation. 

This plan of handling, at least so long as the ovary can be 
reached and grasped, is far preferable to the use of drugs de- 
scribed in our literature as competent to induce labor pains. 
The elimination of corpora lutea, in combination with gentle 
massage, is ineffectual in cows in which a mummified fetus is 
lodged in the uterus, a fact which must be attributed to the con- 
dition of the uterine walls themselves. 

The fact that estrum does not appear while the yellow body 
persists is of great scientific and practical interest. The condi- 
tion that, so long as a corpus luteum persists, estrum does not 



228 Vetermary Obstetrics 

recur and that, if it is removed, the estrum promptly reappears, 
has long been known. Upon this point our statistics teach some 
important lessons. In addition to the persistent absence of the 
symptoms of estrum, such animals show the normal tension of the 
sacro-sciatic ligaments as well as a normal uterus and vagina. 

There is regularly found, in those cases which have not yet 
been handled, in one ovary a yellow body varying in size from a 
pea to a hazelnut or small hickorynut, sometimes inconspicuous, 
sometimes prominent and firm, often easily detached and many 
times removable only with difficulty or even not at all, especially 
when completelj' encapsulated in connective tissue. In rare 
cases, in addition to the foregoing, there maj' exist in the same 
gland a cyst the size of a hazelnut to a hickorynut ; conse- 
quently the ovary is enlarged, smooth and fluctuating on one 
end, while at the other it appears lumpy. 

It is to be observed in the dislodgement of the persistent 
yellow bodies per rectum or per vaginam that, when these co- 
exist in both ovaries, the elimination of the larger corpora lutea 
as a rule suffices, and, when both a corpus luteum and a cyst exist 
in one and the same ovary, the cyst should first be ruptured if 
possible and then the yellow body pressed out. In this con- 
nection, we have noted at times that, after rupturing the cyst, 
the yellow body, which could be clearly recognized but could 
not be dislodged, soon became absorbed and, after a time, estrum 
spontaneously recurred ; on the other hand we have also seen 
under like conditions, after an operative elimination of the cyst 
and with the presence in the same ovary of a persistent yellow body 
which failed to be absorbed, that the cyst only very rarely re- 
turned. If the yellow body is small and not detachable, there is 
yet hope for bringing about estrum through invigorating the ova- 
rian circulation and causing the resorbtion of the corpus luteum 
by the application of vigorous massage to the affected gland. 
After squeezing out the corpus luteum, it should never be neg- 
lected to apply after-compression to the ovary for 10-20 minutes. 
If possible, the tip of a finger, either /.fr rectum or per vaginam, 
should be pressed into the cavity from which the corpus luteum 
has been removed. In the walls of either the rectum or vagina 
the pulsation of an artery is occasionally to be felt, which is 
not to be confounded with the ovarian artery. 



Hypertrophy of the Cotpus Luteunt 229 

The artificially aroused estrum is identical with that occurring 
normally and the percentage of impregnations is as high as in 
spontaneous heat. The artificially aroused estrum appears in 
50 % of the cases on the evening of the third day or on the morn- 
ing of the fourth, in 20 % from 4-10 days, and in 10 % from 
10-28 days after the operation. In 20 % of the operated animals, 
estrum failed to appear. At the point from which the persistent 
yellow body was dislodged there often develop, but not always, 
one or several new corpora in the course of a few days, which, in 
case estrum fails to appear, should again be pressed out. 

IV. Hypertrophy of the Corpus Luteum. 

In this region there is observed not rarely a condition which, 
up to the present, has not been considered in veterinary litera- 
ture as a cause of sterility in cows, the same consisting of a 
hypertrophy of the corpus luteuni. 

The animals which have been affected with this lesion have 
been young cows and heifers, which have in all cases suffered, a 
few weeks to 2 to 4 months previously, from infectious granular 
vaginitis and, after recovery, in spite of estrum having recurred 
regularly and normally every three weeks or in rare cases every 
19-20 days and having been regularly bred to healthy bulls, first 
to one and then another, yet fail to conceive. All animals 
affected with hypertrophy of the yellow bodies show as a rule a 
shortened estrual period of 12-15 hours duration. Rarely, it is 
normal or persists for 48 hours and is too severe, and as a rule 
these animals .show for 2-4 days after estrum a voluminous dis- 
charge of sanious mucus, which is always prognostically bad for 
conception. Examination reveals normal tone and tension of 
the sacro-sciatic ligaments, constant traces of infectious granular 
vaginitis, constricted vulva, normal os uteri and uterus. 

One of the ovaries, and indeed almost always the left, appears 
normal ; the other, even when examined only a few days prior 
to the appearance of estrum, is found affected with one to three 
greatly hypertrophied corpora lutea, and presents prominent, 
deeply fissured, clearly defined outgrowths, as thick as one's 
thumb and as much as 4 cm. long, spherical, papilliform or wart- 
like, at times soft, in other cases firm, elastic in con.sistence. 

Our method of handling consists either of administering daily 
for 6-10 days before breeding, 25-40 grammes of powdered 



230 Veterinary Obstetrics 

myrrh in a liter of water, or, what is more rational, the complete 
elimination of the yellow bodies, followed bj- compression when 
possible of the remnant of the ovary with three fingers or the 
entire hand, through the vaginal wall. 

In pressing out hypertrophied yellow bodies, it occurs excep- 
tionally that the ovary or enlarged yellow body splits into two 
portions, which remain loosely attached to each other. In such 
cases each portion, which is soft and elastic and consequently 
consists only of tissues characteristic of the j^ellow body, is to be 
removed. After the operation the animal shows for from 20 
minutes to three hours a slight arching of the back and elevation 
of the tail, at first slight straining and very rarely a diminished 
appetite at the next feeding time. 

At the point where the corpus luteuni has been pressed out, one 
to several fresh corpora, less developed, generally form within 
3-12 days and indeed we have observed two new corpora in the 
left ovary nine days after operating and three in the right organ 
after twelve days. 

The normal duration of estrum is not affected by this operation 
but in those cases where it was previously abnormally short it 
tends to become normal and our clinical records indicate clearly 
that 95 % of animals .so handled conceive at the first service. 
The hypertrophy of the corpora lutea, like so many other phe- 
nomena in the sexual life of cows, is referable to the irritation to 
the sexual apparatus due to the prior attack of infectious granu- 
lar venereal disease. 



Finally, not only with reference to the indications for castra- 
tion but also from the view point of butter and cheese production, 
we should consider the influence of n5'mphomania and castration 
upon the quality of the milk. 

Prof. Dr. Schaffer, Canton Chemist in Beine, has favored us 
with the following milk analyses and explanatory text with ref- 
erence to the influence of nymphomania and castration upon the 
character of the milk : 

Our literature is contradictory to a marked degree regarding 
the influence of sexual excitement of milking animals upon the 
quality of the milk. While Fleischmann (Landw., Jahrbuch 20, 
Erganzungsband II. S. 192) found a marked diminution of butter 



Injiiie^ice ot Castration Upon Milk 23 1 

fat, Wryssmaun and Peter (Schweiz. Milchztg. 1902, No. 30) 
found the inilk of cows in estrum, in general, somewhat richer in 
cream. Thej' showed e.specialh' in several cases that the per cent 
of fat was decidedly higher for one or two days before estrum than 
during it. Also G. Schroeder (Milchztg. 1874, No. 104) and 
F. Schaffer (Mitteil. d. Naturf. Ges. in Berne 1884 u. Milchztg. 
1885, S. 151) found that the milk of cows in estrum showed a 
high per cent of fat. In the same publication the latter mentions 
a case of continued nymphomania, in which the per cent, of albu- 
minoids and solids was very high, and the rising quality of the 
cream markedly weak, for which two reasons were suggested, 
on the one hand the increased density, on the other, the want of 
large fat globules. 

The influence of castration upon the milk, and especially in 
cases of nymphomania, is, according to all the above investigators, 
favorable. Still our literature contains but few contributions upon 
the matter. Dieulafait (Journ. d'Agric. Pract. 1864 I., P. 519, 
ff. ), as well also as L,. B. Arnold (Milchztg. 1873, S. 337) has ob- 
served, by castration experiments, that the solid contents of milk 
increased and the flavor improved, but the quantity decreased. 
The analyses made by these investigators vary in their contents 
within the boundaries of normal milk. Since castration, espec- 
ially in nymphomaniac cows, is very common in Switzerland, the 
analysis of the milk from these appealed strongly to us. 

For the investigations, milk was taken from nymphomaniac 
and castrated cows. On the whole, the e.Kperiment animals 
under our control were constantly in good general health, the 
udders completely sound and the milk macroscopically normal. 

As experiment animals there were used the cows. Stor, Reh 
and Graf ; Stor and Reh during nymphomania, and Stor and 
Graf after their castration. 

Cow No. I, Stor, Simmerthal breed, about 10 years old, in 
medium condition. The cow calved the last time on June 24, 
[903, and still yielded in January, 1904, three liters of milk per 
milking, and weighed 620 Kg. Since earl}' in December, 1903, 
she had shown well-marked nymphomania, but on account of 
the experiment was not handled. Castration occurred on Feb- 
ruary 18, 1904, and the results were favorable. The first milk 
taken for chemical analysis, after castration, was on May 3, 1904. 



232 



Veterinary Obstetrics 



Cow No. II, Reh, Simraerthal breed, was about 12 years old 
and weighed 6ro Kg. The cow calved the last time on May 25, 

1903, and still gave 3.5 liters of milk per milking, in January, 

1904. The first signs of nymphomania occurred late in October, 
1903, and the neglected disease became very severe in Januarj^ 
1904. 

Cow No. Ill, Graf, Simmerthal type, 7 years old, in good gen- 
eral condition. She calved last on the 23rd of February, 1903, 
became highly nymphomaniac during the summer of 1903, and 
was castrated on the 3rd of the following December. Early in 
January, 1904, she weighed 800 Kg. and on January 13, yielded 
5.5 liters of milk per milking. 

The analysis gave the following results : 



A. MILK OF NYMPHOMANIAC COWS. 



Specific Gravity at 15° C. - 

Solids, '/ 

Fat, '/, 

Albuminoids, % 

Salts, '/r 

Chloriue, '/r of the ash. 
Phosphoric acid '^fr of the 
ash 

Acidity of the milk (after 
Soxhlet, in too cm')__ 



Milk of Cow, No. I. 



Jan. 13 

'04 



1.0342 
13.18 

3-55 
3.86 

0.75 



Jan. 26 
'04 

1.0346 
13.83 
3-98 
4-03 
0.75 



Feb. 15 
'04 

1-0347 
13.88 

4-05 

4-03 

0.78 
11.48 



Milk of Cow, No. II. 



Jan. I3|jan. 26 Feb. 15 

'04 ' '04 '04 



1.0340 1.0358 1.0342 

13.56 14.43 13-75 

4-3 

4.12 

0.80 

14-59 



3.SS 
3-86 
0.76 



3-95 

4-07 

0.79 

115.09 



39.18 29.21 26.25 25.32 '26.18 
7.1° 6.9° 6.3° 8.4° 7.0° 



The reaction to rennet was not remarkable in any test made. 
The milk coagulated under the casein test iu 9^^ to 13 minutes. 
The coagulation was in no test abnormal. Tests of the behavior 
of the milk in the incubator likewise showed normal characters. 

On the other hand, the tests showed, on the whole, a defective 
rising of cream in that, at a temperature of loto 12° C, no evi- 
dent line of demarcation between cream and milk appeared. Meas- 
ured by the micrometer, the fat globules, in the milk of cow 1, 
showed a diameter of 0.0022 to 0.0104, and in cow II, of 0:0017 
to 0.0104 mm. 



Influence of Castration Upon Milk 



233 



B. MILK OF CASTRATED COWS. 



Specific Gravity at 15 C- 

Solids, '/,. 

Fat, Yc 

Albuminoids, % 

Salts, % 

Chlorine, '/r of the ash 

Phosphoric acid, '/n of the 
ash 

Acidity of the milk 1 after, 
Soxhlet, in 100 cm')- 



Milk of Cow in. 

(Castrated on Dec 3, 1903. 1 



Mil/i of Cow I 

(Castrated on Feb. 18 



Jan. 13 

•04 



1.0325 
13-08 

3-95 

3.88 

0.70 
12.76 

29-37 
7-0° 



Jan. 26 
'04 



1.0329 
12.9S 

3.80 

3-43 

0.6S 
12.64 

29.97 

6.7° 



Feb. 15 

■04 



1.0329 
13.11 

3-88 
3-45 
0.70 
13-17 

28.80 

6.8° 



May 3 
'04 



1.0320 
13.02 

3-75 

3-53 

0.70 
13-47 

27.74 
7.0° 



May 3 
'04 



1.0337 
13.28 
3-40 
4.01 
0.77 



29.31 
8.0° 



The behavior toward rennet was not abnormal in any ca.se. In 
the casein test coagulation occurred in 11-13)^ minutes. The 
behavior in the incubator was also parallel to that observed in 
any good, fresh milk. The rising of cream showed nothing ex- 
traordinary in the milk from either cow. The measurement of 
the fat globules in the milk of cow No. Ill, showed a diameter 
of 0.00135 to 0.0193 mm., while that of Cow No. I, gave a meas- 
urement of o.oocig to 0.0149 mm. 

If we now compare the data under tables A and B with each 
other we first observe a higher specific gravity in table A and a 
larger amount of solids than in table B. It is thereby indicated 
that the milk of nymphomaniac cows is not only somewhat richer 
in its contents than that of normal, but also of castrated milk 
animals. In castrated cows, it approaches more nearly the char- 
acter of normal milk. 

In conclusion, it should not be forgotten that a thorough clin- 
ical examination and a rational handling of diseases of the genital 
apparatus of cows, in spite of the many disagreeable features con- 
nected therewith, belong nevertheless among the most important, 
prominent and appreciable dtities of veterinary practice, and not 
alone contribute to the increase of the national resources and 
dissipate errors and discontent in agricultural industries, but 
also add to our knowledge of the cause of sterility, and, not the 
least, add to the well deserved standing of veterinary science. 
In reply to the question as to how we might increase veterinary 
authority and efficiency in this regard, we would unqualifiedly 
answer that, in order to reach this plane with security, a great 



234 Veterinary Obstetrics 

advance can be made in the teaching of veterinarj' students b5' 
the institution of a new and absolutely indispensable course, for 
inexperienced veterinarians, to be known as " Palpation Course 
of the Genital Organs of Cows" and earnestly endeavor to give 
them an extensive practical discipline along this line. Many a 
momentary deep regret and complaint would be spared to our 
younger, enthusiastic veterinarians in agricultural practice, and 
thej- would be led to say : " Labor omnia vincit hnprobus.'" ' 

Cystic or Cysto-Fibrous Degeneration of the Ovaries, 

WITH Nymphomania, in other Animals 

than the Cow. 

On page 194 we have recorded the occurrence of cystic de- 
generation in the ovaries of a goat and of a sow. 

While nymphomania is not extremely rare in all domestic ani- 
mals, it is preeminent!}' common in the cow, not ,so much in a 
specific sense but rather in the closel)' housed and high bred, fed 
and milked dairy cow. 

In economic importance, nymphomania in the mare a.ssumes 
the place next to that of the affection in the da'ry cow while, 
in other animals, it is not of great economic importance. 

Nymphomania in the Mare. 

Nymphomania in the mare is rare in some sections of the 
country, while in others it is quite common and possesses much 
economic importance, not so much because of the failure of the 
affected animal to breed, but because of its decreased value for 
work purposes, owing to the unusual developjnent of disagree- 
able or dangerous vices. 

The symptoms of nymphomania in the mare are, in many re- 
spects, analogous to those ob.served in the cow. There is a fund- 
amental difference, however. The mania in the cow presents an 
obvious relationship to sexual excitement and is expre.ssed chiefly 
by sexual signs, however erratic, but, in the mare, the sexual 
signs tend to assume secondary importance, while the primary 
place is occupied by maniacal symptoms not so readily connected 
with sexual excitement. 

Nymphomania in the mare is most commonly met with in tho.se 



' See foot note on page 161. 



Nymphomania in the Mare. 235 

animals which are kept closely confined and are not bred. It is 
more rarel}' observed in mares regularly worked and is well nigh 
unknown in those which are free, and is most commonly seen in 
young or middle-aged mares, rarely in aged. It is quite uncom- 
mon in mules, though in one instance, we observed the disease 
in so marked a degree as to render the otherwise valuable ani- 
mal worthless. 

The symptoms of nymphomania in the mare usually appear 
just prior to estrum or during that period. As in the cow, so in 
the mare, estrum may occur with comparative regularity, about 
every four weeks but, in some cases, is apparently more frequent, 
while the duration of the period may be so prolonged that the 
intervals of calm between the periods of sexual mania may be- 
come very brief. 

In general, the first symptom of nymphomania, usually ap- 
pearing a few days prior to estrum, consists of excitability and 
irritability of temper, though in some cases this is absent. 

The patient is usually more or less vicious toward other horses 
and toward men. She will bite and kick at her mate or other 
horses when approached. If working with a mate she may con- 
stantly attempt to bite or kick it. Very frequently the patient 
will crowd against the pole of the wagon or other vehicle and 
perhaps lie down upon it in an effort to reach her mate and in- 
flict injury. She manifests her viciousness by laying back her 
ears and .switching her tail, while her eyes and physiognomy in 
general betoken evil disposition. The mere meeting of a strange 
animal of either sex upon the highway frequently arouses a 
maniacal storm ; the mare balks, lies down upon the pole or 
thills, urinates and .switches her tail ; the vulva is rapidly opened 
and closed ; the clitoris is erected ; and the affected animal may 
attempt to grip the reins with the tail, may kick, rear or run 
away. 

Toward persons her disposition is equally disagreeable and, 
indeed, often decidedly dangerous. Upon entering the stall to 
groom, harness, unharness or otherwise handle the animal, she 
is liable to kick, bite or trample upon the attendant without 
warning. In hitching or unhitching the animal, especially when 
working about her posterior parts, she is very liable to kick. 

In the stable, even when no other animal is near, the patient 
may show her vice by kicking the sides of her stall, striking 



236 Veterinary Obstetrics 

and stamping with the feet. In one instance in our clinic, the 
mania was almost exclusivelj^ exhibited when the mare was 
alone in the stall. Watched from a distance, she would stamp 
her feet and kick the sides of the box stall in which she was 
confined. In her maniacal kicking she was utterly indifferent 
of the consequences to herself and would frequently and repeat- 
edly kick one leg viciously with the other. Her eyes were wild 
and staring and her whole appearance and behavior one of 
violent insanity. If her owner or other person entered the stall 
she became calm, began eating or fondled the person with her 
no.se and appeared in every way rational and docile. Turned in 
a paddock, she behaved normally. Hitched in the usual manner 
to a single wagon, she behaved perfectly. The duration of the 
mania and its intensity had increased for some months until the 
degree we have described had been reached and the attacks con- 
tinued during 7-10 days. Ovariotomy was followed by complete 
and permanent disappearance of the mania. 

The distinctively sexual symptoms noted consist chiefly of 
tumefaction of the vulva, injection of the vulvar mucosa, and 
increased secretion of mucus, with some mucous di.scharge from 
the vulva. 

Urination is frequent, while the clitoris is erected and frequently 
protruded between the vulvar lips. The irritability of the vulva 
and vulvo-anal region is markedly increased and the animal fre- 
quently violently resents the handling of these parts. This is 
especially true, in manj' cases, of the tail, the animal resenting 
the raising of it in order to apply the crupper or remove it. 
While driving, should the patient either accidentally or inten- 
tionally get her tail over the reins, she grips them violently, 
kicks viciously, may turn abruptly and up.set or break the vehicle, 
or run away. 

In some cases the patient is perfectly docile and the only signs 
of disease consist of abnormally frequent urination with repeated 
opening and closing of the vulva and the projection of the 
clitoris, making her unfit for driving purposes simply from 
repulsiveness. 

In most cases, however, the patient is unreliable or dangerous 
and cannot be depended upon in moments of emergency. During 
the periods of nymphomania she is very liable to be unsteady in 



Nymphovta7iia in the Mare 



237 



draft work and may at any moment balk and tax the patience of 
the driver very greatly. 

Periodical at first, nymphomania or the vices such as kicking, 
balking and gripping of the reins by the tail, tend to become 
constant and permanent and the animal degenerates into an in- 
curable rogue, falls into the possession of low dealers and finally 
finds her way into some inhuman hands, where she succumbs to 
brutal work. 





Fig. 17. Cysto-fibrous Degeneration of Ovaries. 
From insane mare. 
C, C, C, Cysts. C, L, Corpus luteum. One-half size. 





Fig. iS. Cystic Degeneration of Ovaries. 

From Nymphomaniac Mare. 
A, Sclerotic Ovary. B, Cystic Ovary. 

Examined macroscopically, the ovaries are usually large and 
contain one to several cysts, varying in size from )^-2 in. or 
more in diameter and containing a clear, faintly yellowish 
lymph. The cyst walls are thick and very firm and the density 
of the albuginea preserves to a large extent the even contour of 
the ovarial surface, so that it is only in case of quite large cysts 
that the}' project conspicuously beyond the general surface of 
the gland. In some cases, the ovarian tissue proper vanishes 



238 Veterinary Obstetrics 

almost completely under the pressure of large cysts, so firmly 
compressed within the enveloping tunica albuginea (see Figs. 17 
and 18). In rare instances the cysts become enormous, reaching 
4-8 inches and even more in diameter. 

In other instances of nymphomania we have found, in ex- 
tremely bad cases, small, atrophied, fibrous ovaries, very hard 
and dense, like fibro-cartilage. 

The examination of the ovaries of the mare is to be made 
upon essentially the same basis as that already described for the 
cow. The examination is to be made upon the standing animal, 
due precautions being taken, according to circumstances, to 
avoid injuries to the veterinarian from kicks and to overcome 
any probable annoyance from movements of the animal. Usually 
a single stall, with the animal tied short in it, will sufiice, but 
vicious animals should be secured in stocks, the twich applied 
and a forefoot held up or one hind foot raised by means of a 
sideline. 

The hand and arm of the operator should be well cleansed and soft- 
ened by warm water, and disinfected, and the rectum of the ani- 
mal should be emptied of feces, usually by introducing a warm .soda 
bicarbonate solution into the rectum. The finger nails of the 
operator should be trimmed close and the hand and arm thoroughly 
lubricated with warm oil, lard or liquid paraffin, and then gently 
introduced into the rectum. Usually little progress, if any, can 
be made while the hand is in the posterior or pelvic rectum, but 
it becomes necessary to push the hand gently forwards into 
the free portion of the rectum, which can then be carried to the 
right or left, up or down, and forwards or backwards. The 
mare often strains somewhat, which should always be accepted 
as a signal to the operator to cease his palpation until the expul- 
sive effort ceases, but without withdrawing his hand. Care upon 
this point decreases the straining and does much to avoid lacera- 
ation of the rectal mucosa, associated with hemorrhage. 

With the palm of the hand directed downwards, the cervix 
uteri and uterine body, about the size of a man's wrist, may be 
traced forward to the point of bifurcation, where the cornua, al- 
most as large as the body, are given off at approximately right 
angles. Tracing these to the right or left, the operator can 
recognize the ovaries at or near the anterior margin of the broad 
ligament, an inch or two beyond the obtuse end of the cornua. 



Nyniphoma7iia in the Mare 239 

The normal gland in the young or adult mare is elastic, smooth, 
firm, oblong and about 2j^ — 3^ inches in its greatest diameter, 
by lYi — 2 inches in its lesser diameter. The diagnosis of cystic 
or fibrous degeneration of the ovaries of the mare and the rela- 
tionship between these diseases and sterility is not always clear. 
N)'mphomania in the mare, is, unlike in the cow, most frequently 
observed in those animals not used for breeding purposes at all, 
rarely in those used in constant daily work, and chiefly in those 
more or less contantly stabled, irregularly worked and not at all 
bred. 

How many of them would conceive if bred, we do not know, 
but we do know that many nymphomaniac mares breed and that 
the nymphomania usually disappears during the span of preg- 
nancy, to recur with some degree of regularity after foaling. 
The condition of the ovaries in such cases is unknown. 

It is highly essential therefore that, in examining a mare for 
sterility, a diagnosis should be made only after the most careful 
examination, not only of the ovaries but of all other generative 
organs as well. At the same time, we must have due regard for 
the clinical history of the case and the general condition and 
handling of the patient. 

Treatment. 

Since the ovisacs in the ovary of the mare normally rupture 
only in the hilus of the organ and the tunica albuginea is ex- 
ceedingh' thick and tough^ as compared with that of the cow 
and other domestic animals, the rupture of cysts by rectal 
compression is practically excluded in all cases. The ovary is 
attached so far forwards that it cannot be drawn back and com- 
pressed per vaginam, as in the cow. 

It is possible to puncture the cystic gland by means of a long 
trocar, while the ovary is grasped per rectum ; or a vaginal in- 
cision for ovariotomy may be made, one hand introduced into the 
the peritoneal cavity and the organ directh^ grasped while, with 
the other hand, a long trocar is carefully inserted, and the cyst 
punctured. 

When but one ovarj' is affected, unilateral ovariotomj' may of 
course restore the breeding powers and, in properly selected 
cases, becomes desirable. 



240 Veterinary Obstetrics 

The question of overcoming sterility due to cj'sts or other 
ovarian disease, with a view to the restoration of the breeding 
powers in valuable brood mares, has been quite neglected and 
attention turned chiefly toward the amelioration or cure of the 
vice attending the malady, as symptoms, and thus restoring the 
work value of the animal. Since nymphomania in the mare is 
largely observed onl}^ in those not used or desired for breeding, 
this tendenc3' in handling is natural and quite sufficient in this 
class of cases. It is only when involving animals desired for 
breeding purposes that we are speciallj- concerned from an 
obstetric point of view. When our aim to restore fertilitj^ is 
frustrated by insurmountable obstacles, the duty of the veteri- 
narian yet remains to preserve to the owner, as far as possible, 
any work value which the animal ma}' possess when relieved 
of the nymphomania. 

Three plans for the surgical relief or amelioration of nympho- 
mania in the mare have been more or less advocated : 

I. Clitoridectomy. 

Because some regard the clitoris as the chief seat of irritation, 
from which the nymphomaniac symptoms are reflected, the re- 
moval of this organ has from time to time found advocates. In 
our experience it has not proven its efliciency, though we must 
confess that, owing to our skepticism of its value, we have not 
tested the operation sufiicieutly to warrant our condemning it. 

We can not, however, admit that tjie clitoris is of sufiicient 
importance as a center of sexual reflexes, to warrant the belief 
that its surgical removal will generall)' suffice to eliminate sexual 
mania unless first it be shown that it is in some way organically 
or functionallj' diseased. We freely admit however that clitori- 
dectomy maj-, and does at times, overcome vice akin to nympho- 
mania in some respects, but, in part, this maj' be attributable to 
the physical punishment of the animal under confinement. 
Nymphomania being a reflex nerA'ous disorder, physical punish- 
ment raay at times possibly exert a curative influence. HoUing- 
worth ' records a case in the mare where he obtained relief from 
nymphomania by clitoridectomy, the operation being performed 
under complete chloroform anaesthesia, in which case the cure 



1 Veterinary Magazine, Volume I. • 



Nyinphomania in the Mare 241 

could not be attributed to physical punishment so far as the 
operation proper was concerned and it seems questionable if it 
could be properly referred to the casting and confinement prior 
to the anaesthesia. 

The relationship between the clitoris and sexual desire is by 
no means clear. While disease, functional disorder or irritation 
may arouse sexual desire, it is equally true that the excision of 
the organ does not abolish it nor interfere in the least with 
breeding, as we once witnessd, where some hundreds of sow 
pigs, from which this organ was removed by a travelling im- 
postor who asserted that it destroyed sexual desire and fulfilled 
all requirements of castration, proceeded to copulate as usual and 
bred as freely as though they had not been operated upon. 

As above stated, the nymphomania of the mare most fre- 
quentlj' has its basis in cystic or cysto- fibrous degeneration of 
the ovaries, so far as we have been able to determine in this 
clinic, where we have performed ovariotomy in more than fifty 
nymphomaniac patients. In such cases, excision of the clitoris 
could apparently overcome the nymphomania only by curing the 
ovarial degeneration and it would be difficult to understand how 
such result could be expected. 

We consequently believe that the alleviation of nymphomania 
by clitoridectomy occurs chiefly in those cases in which ovarial 
origin may be doubted and in which the disciplining of the 
patient through casting and securing and, if anaesthesia is not 
induced, the pain caused by the operation effect the alleged cure. 

The operation is simple and free from any notable danger. 
The animal may be cast or secured on the operating table or in 
the stocks and the operation may be performed under general or 
local anesthesia or without either. The vulvar lips may be held 
apart with tenacula or retractors and the clitoris seized by means 
of a tenaculum or tenaculum forceps and, being well drawn out, 
excised with a scalpel at the point of attachment of its crura to 
the ischiatic arch. Quite as conveniently, a longitudinal incis- 
ion may be made from below upwards through the floor of the 
vulva and the organ then excised, after proper dissection from 
surrounding tissues. 

The hemorrhage is unimportant and may be controlled by 
16 



242 Veterinary Obstetrics 

compression for a few minutes by means of forceps. The incision 
through the floor of the vulva may be sutured except a small 
area for drainage. 

2. Caudal Myectomy. 

In dealing with the symptoms of nymphomania in the mare, 
we related the very common and vicious habit of gripping the 
reins with the tail. Following the seizure of the reins, the 
nymphomaniac mare may lean heavily against the pole, kick 
viciously or, turning abruptly, break or upset the vehicle and 
run away. This vicous habit constitutes one of the most danger- 
ous features of nymphomania in the mare, endangering alike 
property and the life of the driver or other persons and of the 
patient herself. Its amelioration or eradication, consequently, 
becomes important. The power of the animal to grip the reins 
may be overcome by myectomy, but this involves ordinarily no 
other effect upon the nymphomania. 

As practiced in this clinic, the animal is confined in the stocks 
or upon the operating table and the tail secured, firmly stretched 
dorsalwards. Under proper antiseptic precautions and after the 
application of an elastic ligature at the base of the tail, two par- 
allel incisions are made directly over the center of the two de- 
pressor coccygeus longus muscles, commencing close against the 
ligature and continuing for a distance of 6-8 inches, through the 
skin and caudal aponeurosis, laying the muscles bare. The 
muscles are dissected away from the surrounding parts and the 
entire exposed portion is excised, after which tampons of anti- 
septic cotton, approximately the size of the excised muscles, are 
laid in the cavities and, over these, an antiseptic bandage applied 
with sufficient firmness to control hemorrhage, after which the 
elastic ligature is removed. 

Properly carried out, the operation leaves the patient with an 
efficient tail in all respects except the power to forcibly grip the 
reins. This power being inhibited, the reins may be easily freed 
by the driver. The vice is thus, in many cases, greatly amelio- 
rated or wholly relieved, but the ovarian irritation presumably 
remains the same, and only the one important symptom, and 
those associated with it, is affected. 

Amputation of the tail, with or without knicking, brings about 
the same result, with the disadvantage, or otherwise, of the loss 



Nymphomania in the Mare. 243 

of the tail. Neither clitoridectomy, caudal myectomy nor ampu- 
tation affects in any way the possibility of breeding. 

3. Ovariotomy. Oophorectomy. 

When nymphomania referable to ovarian disease is present and 
can not otherwise be effectively overcome, castration is indicated. 

In mares not desired for breeding purposes, the cure of ovarial 
nymphomania otherwise than by castration is all too liable to 
prove ephemeral and unreliable, so that castration in these cases 
at once presents itself as the most reliable and enduring remedy. 
The operation is comparatively simple and not highly dangerous. 

It may be performed either in the standing or the recumbent 
position and with or without anaesthesia. In case of a valuable 
pedigreed mare desired for breeding purposes, with but one ovary 
diseased, the operation is to be limited to the affected gland. 

In the standing position, without anaesthesia, the patient is 
secured in stocks, or otherwise, in a manner to prevent lying 
down, kicking or any extensive movements. 

The vulva and vagina, as well as contiguous parts, are well 
washed and disinfected, avoiding always the introduction into 
the vagina of irritant antiseptics. 

After the proper antiseptic precautions have been taken, the 
vagina should be partly filled with a sterilized, warm i % soda 
bicarbonate solution, which will cause the vagina to dilate or 
balloon. This condition having been brought about, the vaginal 
walls are tense and firm and the operative area is above the 
OS uteri externum and standing perpendicular to the long axis of 
the vagina. Through this a stab wound is to be made, directly 
forward, large enough to admit one or more fingers into the 
peritoneal cavity and the opening thus made forcibly dilated by 
the fingers until the entire hand is passed through and the 
ovaries reached. The ecraseur is then carried in, the ovary 
caught in the loop of the chain and the gland promptly detached 
by ecrasement. This usually takes place, so far as we have been 
able to determine, without important hemorrhage. However, in 
one case, when the instrument was too sharp, fatal hemorrhage 
followed. Possibly there is usually a greater amount of hemor- 
rhage than we ordinarily suspect, and it is well to take care that - 
the instrument is sufficiently blunt, as indicated by the force re- 



244 Veterinary Obstetrics 

quired to crush off the gland, lest serious or fatal hemorrhage 
occur. 

Uuder anaesthesia the animal is confined in lateral recumbency, 
preferably upon the operating table, the hinder parts being ele- 
vated, to cause the abdominal viscera to drop forward out of the 
way. Under anaesthesia the vagina does not balloon. The in- 
cision is made at the same point and in essentially the same 
manner. The recognition of the ovaries and their removal is the 
same as in the standing operation. 

The patient is to be kept quiet for 6-8 days on a light, laxa- 
tive diet. If the viciousness continues, the animal should be 
turned out and left without annoyance for several weeks ; if 
docile, she may be put to work. 

In some cases the viciousness may continue without visible 
abatement for a while and later wholly disappear. Too much 
should not, however, be expected from spaying. If a mare is 
fundamentally vicious, little good is to be anticipated from the 
operation, nor is a cure to be confidently expected if the opera- 
tion has been delayed till the vice has become habitual instead 
of periodic. 

Much depends too upon the driver and his method of handling 
the patient ; gentleness, firmness and a display of good judge- 
ment are demanded. The work should be regular and moderate, 
the animal well fed and her general health well guarded. 



Nymphomania and cysts in the ovaries of the smaller animals 
are not common. In the foregoing pages, Hess records instances 
in the sow and goat. We have observed nymphomania in a sow 
without determining the cause. We have also seen a nympho- 
maniac bitch, which was castrated in our clinic and in which 
both ovaries were the seat of enormous cysts, as shown in Fig. 19. 

The diagnosis of cystic ovarian degeneration in the smaller 
animals can only be made by the subjective symptoms of nym- 
phomania, to be verified by laparatomy and direct examination 
of the ovaries. The best treatment is castration, though, in the 
bitch and sow, it is indeed quite possible, in cases where the 
pedigree renders the patient highly valuable for breeding pur- 
poses, to crush or puncture the cysts and return the ovaries into 
the abdomen or, if only one gland is involved, it may be removed 
and the sound one retained, in order that the animal may breed. 



Senile Atrophy of the Ovaries. 



245 




Fig. 19. Normal and Cystic Ovaries of Bitch. 

A, Cystic ovary. 

B, Normal ovary with the pavilion of the oviduct turned back to ex- 
pose the ovary, o. 

C, Normal ovary covered by the pavilion of the tube, showing 
the meatus, M, of the ovarian sac, by which it communicates 
with the peritoneal cavity. 

One-half size. 

7. SeniIvE Atrophy of the Ovaries. 

In aged females, senile ovarian atrophy occurs to mark the 
cessation of the power of breeding and the advent of the brief old 
age of our domestic animals. The advent of this period varies 
greatl}' with species and individuals. Fertility usually persists 
longest in animals regularly bred and well kept, while senile 
ovarian atrophy tends to occur earliest in those animals which 
are not bred and are badly kept or overworked. 

The disease is not to be distinguished, by palpation or macro- 
scopic appearances of the ovaries, from fibrous degeneration in 
adult animals, as already described, except by their very small 
size. It does not induce nymphomania, is not subject to remedy 
and definitely marks the end of the breeding powers of the . 
animal. 



246 Veterinary Obstetrics 

8. Systemic and Painful Diseases. 

Severe systemic affections and painful diseases, which depress 
the general vitality of the patient, tend constantly to prohibit 
ovulation and fertility. It is very rare that the evidences of 
ovulation and estrum occur during the existence of febrile dis- 
orders of any character. Chronic diseases — especially those of a 
systemic character, like rachitis, osteoporosis, and such severe 
bone diseases as are frequent in horses in many regions, and are 
expressed largely by the appearance of multiple spavins, ring- 
bones, navicular disease, lumbar anchylosis, spontaneous frac- 
tures, etc. — tend constantly to induce sterility, due apparently to 
non-ovulation during the active course of the disease, which may 
continue for 2-3 years or more. 

The remedy in these cases evidently lies in the direction of 
overcoming the constitutional malady itself, which is usually 
followed by a restoration of the normal reproductive powers. 



II. DEFECTS AND DISEASES OF THE OVIDUCTS, 
UTERUS, VAGINA AND VULVA. 

I. Arrests in Development of the Oviducts, 
AND Uterus. 

When dealing with arrests in the development of the ovaries, 
on page 155, we necessarily alluded to the concurrent arrests in 
the development of the genital tube. While arrests in the for- 
mation of the genital glands and of the oviducts, uterus and 
vagina are not necessarily parallel, they are quite frequently 
closely associated in the same individual. In Fig. 51 is shown 
the genitalia of a cow, in which the uterine body and the vagina 
are wanting and are replaced by two adherent, parallel cords 
representing the Miillerian ducts. In freemartins and herma- 
phrodites, arrests in development of the uterus and oviducts are 
common. In one instance occurring in our clinic, a filly was 
presented, with the history that she had an annojang mucous 
discharge from the vulva. Palpation revealed that that portion 
of the ducts of Miiller which should have formed the uterus 
had instead developed the characters of a vagina. A slight con- 
striction denoted the location of the cervical canal but, beyond 
this, the tube had all the characters of the vagina itself ; its 
mucosa was identical with that of the vagina so far as the sense 
of touch revealed and the function of the tube was also vaginal 
in character, ballooning promptly upon palpation, wholly unlike 
the uterus. 

While aberrations in the development of the oviducts and 
uterus are somewhat rare, the possible variations in such aberra- 
tion are extreme and their character must be determined bj'^ 
palpation, either through the rectum or the vagina. 

Such aberrations in development are rarely, if ever, subject to 
remedy, and their diagnosis and the determination of thecharacter 
of the sterility, whether it be permanent or removable, is the 
chief question to be decided by the veterinarian. 

2. Salpingitis and Occlusion of the Oviducts. 

Inflammation of the oviducts, accompanied by suppuration, ab- 
scessation and occlusion, is somewhat rarely recognized in veter- 
247 



248 Veterinary Obstetrics 

inary practice, partly, perhaps, because it is quite rare, probably 
largely owing to the fact that its occurrence usually passes un- 
recognized. The oviducts, when felt per rectum in the cow, 
are somewhat difficult to distinguish, as very small, dense, tor- 
tuous cords, extending from the apex of the uterine cornua, 
toward the ovary, in the anterior portion of the broad ligament. 
They are about y'g of an inch in diameter. 

In dealing with diseases of the ovaries on pages 177 and 193, 
reference has been made to recognized pyosalpinx, or abscess of 
the oviducts. Abscess of the ovaries, which we have mentioned 
on page 217, is presumably due to the passage of pyogenic bac- 
teria from the uterine cornua, through the oviducts, to the 
ovaries, there to find lodgement and multiply. In thus travers- 
ing the ducts, a more or less pronounced salpingitis would tend 
to occur and this is verified by sufficient clinical and post mortem 
observations. 

The causes of salpingitis, so far as determined, are largely, 
infectious granular vaginitis in the cow, and retained placenta, 
especially following contagious abortion in the cow, and other 
animals. In tuberculosis and some other affections, the ovi- 
ducts may rarely become inflamed and enlarged so that, accord- 
ing to Zschokke, they sometimes attain the size of a lead pencil. 

The sj'mptoms have usually passed unobserved, except as re- 
lated to sterility, the disease leading rarely to nymphomania. 
Its diagnosis can rest only upon palpation per rectum or va- 
ginam, by which the ducts may be found enlarged, and their 
consistence altered. They may be either soft or hard, and may 
contain abscesses or contents of variable character. 

The prognosis of salpingitis and pyosalpinx is always grave. 
The disease may abate and the organ recover, but the possibility 
is a remote one, since any extensive inflammation is likelj' to 
lead to adhesions and occlusion which determine permanent ster- 
ility. If but one tube is involved, it may be surgicallj' removed 
and the patient rendered capable of breeding. 

3. Metritis. 

Metritis tends in all cases to induce sterility in all animals, 
sometimes temporary, frequently permanent. The malady occurs 
under a variety of forms, due to a multitude of causes and having 



Metritis 249 

a varying significance for the fertility of the animal. The chief 
varities to be considered are : 

a. Acute metritis occurring in all species of animals, follow- 
ing closely upon parturition or abortion and resulting from infec- 
tion entering the uterus as a result of manipulations during 
parturition, or from retained, decomposing afterbirth or related 
causes. The malady is necessarily considered later among the 
" Puerperal Infections ", to which the reader is referred. 

b. Chronic metritis, pyometra or myxometra. — Chronic 
purulent metritis (pyometra) and muco-purulent metritis (myx- 
ometra), as related to ovarian disease, have already received con- 
sideration on page 222, and need not be repeated here. 

These affections occasionally follow parturition, especially 
when accompanied by d3'stocia, or when parturition is succeeded 
by retention of the fetal membranes. This type, like acute 
metritis, is necessarily considered among ' ' Puerperal Infections ' ' 
and, accordingly, need not be repeated here. 

c. Chronic metritis, or pyometra, also occurs in non-breeding 
females, so far as we know, wholly independent of ovarian disease 
and non-puerperal in character, as it may appear in an animal 
which has never bred or in one which has not recently bred. 
This type of cases is so like those in the preceding class in 
S3'mptoms, prognosis and handling that they may be most profit- 
ably and concisely dealt with in the same chapter. 

Closely allied to chronic metritis, also, is " Uterine Ab- 
scess," which, following usually some puerperal infection, is 
naturally dealt with in that group. 

All these forms of disease inevitabl)^ cause, during their course, 
sterility, which may be rendered permanent b^' the changes re- 
sulting in the organs involved. Salpingitis, pyosalpinx and 
occlusion of the oviducts are constantly threatened in the course 
of these maladies, while ulcerations and erosions of the uterine 
mucosa may lead to adhesions between the uterine walls and ob- 
literation of the cavity of the cornua, uterine body or cervix. 
But such is not always true. The author recalls delivering a 
cow after ten days of dystocia, with a badly decomposed fetus, 
intense metritis and enormously thickened uterine walls. A few 
months later she conceived. 

Since all these forms of disease have been, or will be, con- 
sidered in other chapters, it suffices to mention them here as 



250 Veterinary Obstetrics 

important maladies in reference to sterility. The prognosis in 
these cases depends upon the promptness and efficiency of the 
handling, questions which are fully discussed in the chapters 
already mentioned. 

4. Edema of the Uterine Walls. 

In very rare instances, edema of the uterine walls has been 
recorded, the edematous enlargement being so great as to simu- 
late pregnancy. Necessarily, it induces sterility and, so far as 
known, the condition is incurable. 

5. Tumors of the Uterus, Vulva, Vagina and of the 
Broad IvIGAments. 

Tumors involving the uterus of the domestic animals are not 
at all common and plaj' no very important role in the question 
of sterility. Zschokke claims that the most common tumors af- 
fecting the uterus of the cow are fibroma and lipoma. 

Tumors of the vagina and vulva are more common than those 
of the uterus. Perhaps the most common place for the occur- 
rence of benign tumors is on the line of demarcation between 
the vulva and vagina, that is, at the site of the hymen. They 
usually originate from the mucous membrane and, when located 
in the vagina and vulva, tend to assume the polypoid form and 
may vary in color according to their vascularity. The fatty 
tumors arise in the pelvic connective tissues and press upon the 
vagina in a manner to more or less narrow it. 

Occasionallj' we meet with enlargements along the floor and 
sides of the vagina, due to a collection of secretions in Gartner's 
canals. These present themselves as elongated, fluctuating 
tumors, which begin near the meatus urinarius and extend, in a 
divergent manner, obliquely forward and upward along the sides 
of the vagina. These retention cysts are easily diagnosed. 
When veiy large, they cause some narrowing of the vagina and 
may interfere with coition or parturition. 

Tumors of the vulva and vagina which have pedicles are easily 
and quickly removed with the ecraseur. When the tumors are 
sessile, it is necessary to use the scalpel or scissors for their re- 
moval. These operations should be carried out under strict an- 
tiseptic precautions and, so far as possible, perforation of the 
peritoneal cavity should be avoided. If proper aseptic care has 



Tumors of the Uterus, Vulva, etc. 251 

been taken, perforation is important only because of possible 
prolapse of the intestines or other viscera. The prolapse may 
be prevented by appropriate sutures. Where the possibility is 
foreseen, the tumor, with a section of the vaginal wall, may be 
removed by ligature. 

Retention cysts of the genital passage may be laid open freely 
with the scalpel, under strict asepsis. 

Diseases of the broad ligaments are rare. Yet, they occur 
with sufficient frequency to merit attention. So far as we are 
aware, they occur chiefly in the cow. 

Various writers refer to tubercular deposits in the broad liga- 
ment, which cause them to become thickened and, upon palpa- 
tion, to give the ordinary characteristics of tubercular invasion. 
In addition, there are also symptoms of the disease in other parts 
of the body. 

In one very interesting case of sterility, in a highly valuable 
pedigreed Holstein cow which we attended, it was found that 
the broad ligaments were the seat of eight or ten large abscesses 
with very dense capsules. The uterus and broad ligaments were 
adherent, over a large part of their surface, to the rectum and 
surrounding organs, and the ligament was invaded by multiple 
abscesses containing from two to five or six ounces of pus each. 
The contents of the abscesses were of a yellowish, granular 
character, which seemed strongly suggestive of actinomj'cosis. 
This impression was fully verified by microscopic examination. 
Although a careful search was made, no signs of actinomycosis 
were found elsewhere within the body. The case suggests that 
the infection probably occurred through the medium of copula- 
tion. 

Tuberculosis of the uterus has been alleged to be a frequent 
cause of sterility, but we have few data in support of the pre- 
sumption. Angst' records that, out of 34 sterile cows, 31 were 
affected with uterine tuberculosis ! 

Actinomycosis and tuberculosis of the uterine ligaments or 
walls, are usually not subject to remedy. L,imited actinomy- 
cosis might possibly be relieved by the internal administration of 
potassium iodide. 

' Deutsche Tierartzlichen Woclienschrif 1,1898. 



252 Veterinary Obstetrics 

6. Occlusion of the Os Uteri. 

Except during the time of estrum or at the period of birth, the 
OS uteri externum is normally closed in all animals to such an' 
extent that the folds of the mucous membrane of the cervix are 
firmly pressed together, so that some degree of force is required 
to pass any object of size through it. The degree of closure 
varies greatly in the different domestic animals, being most 
marked in the cow and the least so in the mare. In the cow, the 
cervical canal is long and tortuous and the cervix itself is thick 
and firm, apparently almost tendinous. The circular muscle 
fibres of the cervix of the cow and other ruminants are very 
numerous and powerful and maintain the closure of the canal in 
a very effective manner. In the cow, the mucous membrane is 
thrown into the numerous longitudinal folds common to the uteri 
of all animals, and, in addition, there are two or three transverse 
ridges of mucous membrane surrounding the canal in such a 
manner that it becomes exceedingly diificult to pass a sound 
through it, from the vagina, into the uterine cavity. 

The physiologic dilation of the cervix during both estrum and 
parturition is not well understood, but seems to be due to a 
nervous reflex. We have already related, on page 32, that the 
vagina has an inherent power of dilating under sexual excite- 
ment. This is seen most marked in the mare and less so in the 
cow. Zschokke attributes this spontaneous dilation of the vagina 
of the cow to the contraction of the longitudinal muscle fibers, 
and to the action of the ischio- vaginal muscles upon those fascise 
which extend deepl)' into the vagina. He suggests that it is 
possible that this dilation of the vagina acts upon the mouth of 
the uterus and tends to widen it. As already stated, we con- 
sider that the reasons advanced by Zschokke are open to question, 
since the contraction of the longitudinal muscle fibers should 
tend rather to bring the walls together than to separate them. 
The explanation for the ballooning of the vagina requires further 
study, but we agree with Zschokke that it probably has an influ- 
ence upon the dilation of the os uteri. 

The closure of the cervical canal must be referred to the firm 
contraction of the circular muscles of the part. In the cow, the 
density of these muscles is so great, and their contraction so 
firm, that, except during the periods of estrum and parturition, it 



Occlusion of the Os Uteri 253 

is exceedingly difficult to insert even the little finger through the 
canal into the uterus. lu a perfectly normal uterus of the cow, 
it usually requires half an hour to one hour of hard work to dilate 
the part sufficiently to insert an index finger. The cervix of the 
cow is so hard that it frequently leads the inexperienced veter- 
inarian to diagnose sclerosis when it is perfectly normal and thus 
lead to an error in reference to the cause of sterility and an equal 
mistake in applying remedies for the sterility. Zschokke has 
searched in vain for cartilaginous tissue in the cervixes of cows, 
but has occasionally met with an excess of connective tissue' 
which has led, in his judgment, to some sclerosis. Even this, 
he admits, is very seldom. Zschokke, in his extensive experience, 
has never met with a case of atresia of the os except as a con- 
genital affection, and even then only very rarely. 

It is very evident that, if the mouth of the uterus is completely 
closed, neither the penis nor the semen can enter, because of the 
anatomical relations, which have been already discussed. It is, 
accordingly, an old custom in all countries to examine the cervix 
uteri in cases of sterility to determine if it is open or not. 

The frequency' of occlusion of the os uteri is a question which 
admits of much discussion and which is differently answered by 
different practitioners. In the judgement of some veterinarians, 
it constitutes the chief cause of sterility, while by others it is re- 
garded as a very rare and more or less mythical condition. Hess 
passes over the question of occlusion of the os very lightly, while 
Zschokke considers it of much importance and of comparatively 
frequent occurrence. Bass deems it one of the great causes of 
sterility in the cow. 

It is difficult to harmonize these conflicting views. It is con- 
stantly to be remembered that an os uteri is not closed, so far as 
conception is concerned, so long as the canal will admit of the 
passage of a small probe. There is no essential reason why the 
OS uteri externum should be any wider than the canal of the 
oviducts, which barely admit the passage of a large horse hair. 
The anatomical character of the cervix of the cow renders it ex- 
ceedingly difficult to determine if such a passage exists or not, 
until the os has been sufficiently dilated to permit the passage of 
a finger into the uterine cavity. According to Zschokke and 
others, the occlusion of the os, or a harmful stricture, has been 
met with in animals which have recently given birth to young 



254 Veterinary Obstetrics 

and has been followed by a vaginal discharge, presumably due to 
endometritis. In other cases, it occurs without any preceding 
disease. 

We have indeed very little in our veterinary literature to 
thoroughly demonstrate the closure of the os uteri, as verified 
by post mortem examination, and the diagnosis has usually 
been based upon the difficulty of introducing a finger through 
the cervix into the uterine cavity. This, as we have already 
stated, is well-nigh impossible, at most times, in the normal 
uterus of the cow. 

In the mare, closure of the os uteri is stated to occur, and 
doubtless does, but in our experience we have never seen such a 
case except in some di.sease of the uterine cavity itself, such as 
pyometra or uterine abscess, in which the cervix becomes sclero- 
tic and in which, sometimes, as observed by us clinically, a com- 
plete closure of the canal results. 

The diagnosis of closure of the os uteri is very difficult in the 
cow, still more so in the small domestic animals, but there is no 
difficulty ordinarily in the mare. If the uterus of the mare is 
normal, the index finger can readily be passed through it, even 
when she is not in estrum. During estrum, it is not at all rare 
to find the os of the mare so open and flaccid that the entire 
hand may readily be introduced through it. 

In the cow, we should preferably examine the animal for sus- 
pected closure of the os uteri during the period of estrum, be- 
cause the canal is naturally more dilated and dilatable at that 
time. The best method for examining the cervix is to grasp it 
per rectum with one hand, so as to fix and hold the cervix in a 
direct line, and then test the patency of the cervical canal with 
the index finger of the other hand or with a sound. One of the 
great difficulties in passing either the finger or the sound is the 
aforementioned transverse folds of mucous membrane, which 
tend to obstruct the passage and may lead to the conclusion that 
the canal is closed when, in fact, the sound or finger has simply 
been caught in one of these folds, and the cervical canal 
is wholly normal. Another serious difficulty is that, unless 
the cervix is fixed per rectum, as suggested, the pressure neces- 
sary to force the finger or sound through the canal causes the 
cervix to bend acutely, or even at right angles, and thus cause 
the finger or sound to be forced against the wall of the cervix, 



Ocdusiott of the Os Uteri 255 

which has now become perpendicular to the long axis of the 
finger or sound. In this way, we have known the operator to 
force his finger through the walls of the cervix into the 
peritoneal cavity while attempting to "open" a cervical canal 
which was not "closed", but perfectly normal. 

The diagnosis of occlusion of the cervical canal, as already 
suggested, is all too frequently m}'thical and based upon un- 
scientific grounds. The occurrence of the condition is freely 
admitted and verified by clinical and post mortem examinations, 
but the frequency of pathologic occlusion, of a degree to actually 
constitute a fertility destroying closure, is a debatable question 
of great significance. 

When is the os uteri closed to a degree to interfere with or 
prevent fecundation? Few will answer it alike. If we knew 
better the exact relation of the organs during copulation, the 
answer might be more specific. 

Some claim that, during copulation, the glans penis enters the 
OS uteri. As proof, they cite uterine laceration or perforation 
alleged to have resulted from copulation, but can adduce from 
the pages of veterinary literature but one or two cases. The 
records are not wholly convincing in the one case we have found 
recorded. Even if it occurred, as alleged, the fact of serious or 
fatal injury would indicate rather that it was due to abnormal 
copulation. 

It is fair to assume that manual exploration of the vagina in 
estrual animals induces conditions somewhat analogous to those 
obtaining during copulation and .there is certainly little therein 
to suggest that the penis enters the cervical canal. The os 
uteri, while distinctly dilated as compared with the condition 
observed during the interval between estrual periods, is never- 
theless closed too firmly to make the entrance of the penis into 
it comprehensible. It is to be further noted that, when the so- 
called ' ' impregnators ' ' are used in the mare and inserted in the 
os uteri externum immediately prior to service, the apparatus is 
not dislodged by copulation, as would inevitably occur should 
the penis enter, or even pre.ss hard against, the os. 

In the cow, the canal is too small and tortuous to permit the 
penis of the bull to enter it, especially with the sudden and 
violent thrust made by that animal. The same holds true for 
other ruminants. 



256 Vetermary Obstetrics 

Others maintain that, during copulation, the meatus urinarius 
of the male penis is pressed against the os uteri externum of the 
female at the moment of ejaculation and that the semen is in- 
jected direfctly into the uterus through the cervical canal, 
lyittle evidence exists in favor of such assumption and much 
against it. In the mare, it is especially notable that large 
quantities of semen are expelled from the vulva immediately 
after the completion of copulation, which would signify that it 
had probably not passed be3'ond the vagina. If the vaginal 
cavity is examined immediately after copulation, large quantities 
of semen will be found,, in it, apparently the normal volume dis- 
charged at a single copulation. If this is largeh^ expelled from 
the vagina immediately after ejaculation, it would scarcely 
appear that it was first thrown into the uterine cavity or cervical 
canal, but that it was discharged against the anterior wall of the 
vagina, especially the os uteri externum, and that only a very 
small proportion of the fecundating cells pass beyond the vagina 
to assume an}' important part in the process of fertilization. 
Some of the spermatozoa pass through the cervical canal, uterine 
and cornual cavities, reach the oviduct and meet the ovum or 
ova, where one male cell serves to fecundate each female cell or 
ovum, .while the other spermatozoa perish. Most of the sperm- 
atozoa are expelled from the vagina immediately after copulation. 

Occlusion of the os uteri, as a fundanie7ital cause of sterility, con- 
sists of such complete atresia, or closure, of the cervical canal as to 
re?ider the passage of the microscopic spematozoa improbable or im- 
possible. In the oviduct with a canal admittijig a large horsehair, 
the size of the cha^uiel is abundayit for purposes of fecundation and, 
so far as we cati deterinine, a like opening tlwough the cervical 
canal fulfills all deinandsfor impregnatio7i. 

According to this view, the smallest recognizable opening 
through the os uteri and cervical canal constitutes a reproduc- 
tively normal condition and, ere we can diagnose occlusion of the 
OS, we need to determine that the passage of microscopic sperma- 
tozoa, endowed with vigorous motile power and in their normal 
element, is impracticable. Hence, in our judgement, if the 
smallest sound, possessing adequate rigidity to render its insertion 
practicable, can be passed through the cervical canal without 
undue force, the diagnosis of occlusion of the os uteri is not 
warranted. 



Occlusion of the Os Uteri 257 

When closure of the cervical canal has been definitely di- 
agnosed, it becomes evident that the most direct and only 
hopeful method of dealing with the consequent sterility is by 
its artificial dilation. 

The manual dilation of the os uteri should be carried out under 
the strictest aseptic precautions in order to avoid an inflammation 
of the parts, which must be more or less injured during the pro- 
cess. In the cow, the dilation must be very gradual and its 
accomplishment requires much patience. As suggested above, 
it is best, where we wish to use force in penetrating the cervical 
canal, to first grasp the cervix uteri per rectum with one hand 
and then carry out the dilating operation with the other hand in 
the vagina. The operator should have the finger nails well 
trimmed and perfectly smooth, the hands clean, disinfected and 
well softened. The hand should be oiled or should be moistened 
with some unctuous substance, like a solution of sodium bicarbon- 
ate or a weak solution of salt at a temperature of about 100° F. 
The index finger should be pushed gently into the os with a 
rotary motion and advanced until resistance disappears and the 
finger tip enters the uterine cavity. After persisting in the eifort 
for a considerable period of time, until the finger becomes tired 
and the animal considerably irritated, it maybe best to desist for 
a while and renew the operation some hours later or upon the 
following daj'. 

Zschokke condemns the use of wooden or metallic sounds in 
bringing about this dilation because he considers them dangerous. 
We hold, on the other hand, that they are quite as safe as the 
finger, providing, always, that the precaution is taken to first 
grasp and fix the cervix with one hand per rectum, in which 
case the progress of the sound may be constantly determined and 
the operator can know exactly if it is following the central line, 
that is, the cervical canal, and may determine when it has reached 
the uterine cavity. 

We even regard a metallic sound as distinctly safer, easier to 
manipulate, and more effective than the finger, in dilating the 
OS or diagnosing its patency, because it can be much smaller and 
more even than the finger. For the cow, this instrument should 
be of well tempered, plated steel, i\ to \ inch in diameter at the 
point, 18 to 20 inches long and furnished with a handle con- 
17 



258 Veterinary Obstetrics 

venient for manipulation. Some writers advise a curved point, 
but the canal it is to penetrate is direct and the instrument 
should be straight. 

An interesting question in the dilation of the cervical canal is 
that in relation to the use of local anaesthetics, such as cocaine, 
stovaine and others. We find no records of the use of these 
drugs for this purpose. It would seem to us, however, that two 
very marked advantages might result. First, the use of these 
substances might diminish the resistance and straining, by 
obviating the pain incident to the process, and thus do away 
with one of the chief hindrances in the operation. In the second 
place, we have found that stovaine, especiall}', paralyzes motor 
nerves and it would appear to us that, if injected into the walls 
of the cervix, it might inhibit the muscular power and render 
the dilation of the canal easy, if not in itself accomplishing the 
desired end. 

The smearing of the cervix of the uterus with belladonna and 
other similar substances, with a view to relaxing the parts, has 
not been followed by success, according to our observations. 

Having already indicated our skepticism concerning the scien- 
tific basis for attributing a large percentage of instances of 
sterility to occlusion of the os uteri, it is essential to discuss 
freely the prognosis of dilation in the presence of this alleged 
cause. Numerous contributions appear here and there, in which 
excellent results are recorded from ' ' opening ' ' the uterus and 
it is a common practice among stallion grooms to ' ' open ' ' the os 
in mares which fail to conceive at the first or second service. It 
becomes an exceedingly difiicult and delicate task to differentiate 
between fact and fancy, between science and mysticism. 

Except we have first learned positively that a barrier to 
fecundation, not spontaneously removable, exists, we are not 
prepared to say that a given coition will or will not prove suc- 
cessful because preceding copulations, be they one or many and 
distributed over months or years, have failed. Without " open- 
ing", without mystical concoctions, without interference of any 
kind, we have observed the sudden and unexpected appearance 
of fertility after barrenness, in mares, from maturity up to the 
age of 10 or 12 j'ears or more. In such cases, the reasons for 
the final conception and prior sterility remained equally impene- 
trable enigmas. 



Occhision of the Os Uteri 259 

So, if a series of females which have failed to conceive are 
"opened", are drugged with this or that nostrum, have yeast 
injected into their vaginae, have " impregnators " applied, or 
resort is had to artificial impregnation, some of them, possibly 
all, maj' conceive. 

It is possible, though, we believe, highly irnprobable, that the 
forcible dilation of the cervical canal may indirectly favor fecun- 
dation. The discharge of viable ova into the oviducts is a reflex 
act. We know too little of the causes of the maturation and 
rupture of the ovisacs and the part played therein by reflexes 
from the other portions of the genital apparatus. 

It is believed by many breeders, and apparently not without 
reason, that sexual excitation tends to hasten and even determine 
ovulation and hence some breeders practice forced service, at 
times, in order to hasten or insure estrum and ovulation. It is 
common experience and observation that the proximity of a male 
stimulates sexual appetite in the female, and we have good reason 
to assume that, with it, is associated the stimulation of ovula- 
tion. If this be true, we are not in a position to deny that the 
manual or instrumental dilation of the cervical canal may stimu- 
late normal ovulation and hence indirectly favor conception. 

We cannot, however, in the present state of our knowledge, 
place scientific reliance upon dilation of the os uteri as an effect- 
ive remedy for sterility, except in isolated cases. 

On the other hand, there is much in the ordinary "opening 
of the uterus " which is in violation of all surgical principles. 
Time and again we have watched the stallion groom, without 
any precautions whatever, proceed with his operation. Some 
dirty water in a filth}^ stable pail, to which is added some irritant 
laundry soap, is used as a lubricant for the dirty unwashed 
hands- of the groom, while the long and rough finger nails, con- 
cealing abundant filth, receive no attention. The rough, dirty 
hand is forced through the vulva and vagina with scant regard 
for their delicacy, and is then rudely forced onwards through the 
cervical canal, tearing the tissues and inducing extensive hemor- 
rhage so that the hand, when withdrawn, is covered with blood. 
The character of the uterine cervix of the cow renders such an 
operation less practicable and it is virtually impossible, within a 
reasonable time, to force the entire hand into the uterine cavity. 



26o Veterinary Obstetrics 

We have known, however, a veterinarian to force a finger 
through the cervical walls into the peritoneal cavity. 

Sober consideration must convince anyone that such rough 
methods are not onlj' antagonistic to the production of the desired 
result, but actually dangerous for the well-being of the patient 
and profoundly repulsive from a surgical standpoint. 

A rudely dilated os uteri means hemorrhage into the cervical 
canal, with consequent blood coagula in the parts, which, if the 
animal is at once served, would seriously impede, or prevent, the 
passage of spermatoza through the canal. At the same time, 
the pain from the physical injuries will cause straining and tend 
to result in an unusually and injuriously complete expulsion of 
the .semen. 

If time is permitted to elapse after the operation before serv- 
ice is permitted, the injured parts become inflamed and swollen, 
and the closed os more tightly closed than before the operation. 
Infection almost inevitably contributes to the dangers to the life 
of the spermatozoa. 

These conditions not alone tend to prohibit impregnation, but 
endanger the health of the genital passages, by planting infec- 
tion in the injured tissues and, in our clinical experience, chronic 
pyometra has followed " opening " so closel}' in some cases as to 
point to the rude operation as the probable basic cause of the 
malady. 

Others, especially veterinarians of excellent repute, instead of 
resorting to these rude and barbarous means of dilation, apply, 
the more scientific and far less dangerous expedient of intro- 
ducing, into the cervical canal, sponge or kelp tents, which, 
through the absorption of fluids, swell up and gentlj' dilate the 
canal. Admittedly they are far milder and safer. But they are 
only applicable in those cases where the canal is already permea- 
ble, as they cannot otherwise be inserted. As above suggested, 
when the canal is penetrable, the further dilation is, in our 
judgment, unnecessary, if not wholly unwarranted. 

Nor is the danger from infection wholly obviated. Any foreign 
body, unless it be permanently aseptic or antiseptic, invites infec- 
tion in the part and, when the dilating body is removed and the 
infection left behind, it remains as a menace to all spermatozoa 
which must pass through the infected tract on their way to con- 
jugation with the ova. 



Ato7iy of the Genital Tract, etc. 261 

On the whole, therefore, we consider that the manual or 
mechanical dilation of the cervix uteri should be strictly limited 
to those cases where the sterility is traceable to a definite ob- 
struction in the canal, which it is possible to overcome by the 
operation. 

Hypertrophy of the Os Uteri. — Aside from the closure of 
the OS uteri, Zschokke, Hess and others have observed hyper- 
tropli}' of the cervix as a hindrance to impregnation. In these 
cases, the os uteri externum projects far into the vagina, and is 
enlarged and firm. Zschokke has found this condition onlj' in 
old cows which had repeatedl}' given birth. Hess believes that 
this condition may be transmitted to the offspring. The condi- 
tion consists chiefl}' of a hypertrophy of the mucous membrane 
and the folds may reach ten times their normal size. Some 
veterinarians have recorded tuberculosis of the cervix uteri. 
Zschokke alludes also to the formation, about the os uteri externum 
in cows, of mucous membrane flaps as much as 6 cm. long, which, 
in his judgment, might act as a hindrance to the migration of 
spermatozoa through the cervical canal. In the mare this con- 
dition is very common in conjunction with general atonic condi- 
tions of the genital tract, which we consider below, where we 
shall deal with the problem of handling. The general handling 
of hypertrophy of the os uteri, or vaginal portion of the cervix 
uteri, must usually be coupled with an unfavorable prognosis. 
If the condition is static, if no active disea.se processes are present, 
and it is believed that parturition could be safely accomplished, 
artificial insemination maybe successfully applied, if a small- 
caliber syringe nozzle can be introduced through the hypertrophied 
organ. If active disease processes are present, appropriate 
remedies should be applied for their cure. In general, however, 
the condition is beyond remedy. 

7. Atony of the Genital Tract and Dilation of the 
Cervix Uteri. 

In contrast to constriction or occlusion of the os uteri externum, 
we more commonly meet in the mare with an abnormal dilation 
of the passage. The os uteri is unusually wide open and flaccid 
and readily admits of the entrance of several fingers or of the 
entire hand. 



262 Veterinary Obstetrics 

There is present a general flaccidity of the genital tract, the 
mucosa are somewhat injected and there is an increased secretion 
of mucus. The malady occurs usually in adult or old brood 
mares, but we have observed it in fillies. As a rule it is observed 
in idle, highly-fed animals which have grown over- fat. The 
condition of the genital tract is simply the result of the general 
atonic state of the animal, caused by injudicious management. 

Along with this condition, the mucous membrane about the 
OS uteri externum becomes hypertrophied and developes exten- 
sive flaps of mucous membrane, which hang down over the os 
like curtains. These may mechanically interfere with insemina- 
tion, as they act somewhat as valves and may possibly tend to 
deflect the spermatozoa from the cervical canal. 

The handling of sterility due to these causes must be directed 
primarily to the removal of the causes themselves and secondarily 
to relief from the changes which have occurred in the genital 
canal. 

First, the patient should be so handled as to restore the normal 
systemic tone. Idleness and obesity are to be supplanted by ex- 
ercise, or by work of such a degree as to restore the general 
tonicity. This is not always easy of accomplishment in a harem 
of mares used wholly for breeding. In some manner, exercise 
should be enforced. When at pasture, the food supply should 
be reduced, by restricting the area or increasing the number of 
animals within the enclosure, to such a point that the mare must 
exert herself to a reasonable degree in order to secure the amount 
of food necessary to maintain good physical condition, and thus 
overcome the obesity and want of tone. A quiet mare, especially 
of the draft breeds, will not exercise unless compelled to do so 
in order to obtain food, water or shelter. The mere provision of 
a sufficient area, in which exercise may be taken, by no means 
assures exercise, except it is made necessary. If abundant food 
and water are close at hand, the animal will move far enough 
to procure these and generally stop, content with these. 

Even greater care is essential in order to secure adequate 
exercise in winter. If abundant food and water are supplied at 
the stable, the animal is often too content to remain idly near 
the stall, even though a large enclosure is open to her, whei e 
vigorous exercise could be had. 



Loss of Cotyledons 263 

If the food supply is limited, and an extensive field is open to 
the animal, in which some food can be procured only by more 
or less vigorous exertion^ she will promptly take this exercise in 
order to provide the additional food, for which the system craves. 

Best of all is work. Mares moderately, or even hard, worked 
are always among the most regular breeders. It is not rare for 
mares, which have long been sterile, to breed after being placed 
at steady work for a long enough time to bring them into good 
working condition, with a general vigorous tone. 

Locallj', something may be done to restore the genital tract 
to its normal tone. The congestion and atony may be largely 
alleviated by astringent douches, such as solutions of alum or 
tannin. Should there seem to be important infection, adequate 
disinfection should follow. Powdered tannin and iodoform may 
be introduced into the uterine cavity in gelatin capsules, and 
these crushed or opened so that their contents may at once escape. 

The curtain-like flaps of mucous membrane may be snipped 
off with long scissors or removed by other convenient means. 
In all such cases the ovaries, oviducts and cornua should be 
carefully searched for abnormalities, and should any be found, 
appropriate measures applied. 

8. Loss OF Cotyledons. 

It has been assumed by some that the loss of the cotyledons in 
ruminants serves to cause sterility, but Chauveau and others 
have experimentallj' removed all the cotyledons which could be 
recognized, without inducing sterility. New cotyledons were 
formed to maintain the functions of the uterus. 

Clinically, the pathologic destruction of the cotyledons does 
not necessarily lead to sterility. In retained afterbirth, placen- 
titis frequently follows ; the cotyledons may be surgically re- 
moved in order to overcome the disease ; or they may become 
necrotic and slough off and yet sterility not ensue. We have 
removed all recognizable cotyledons in order to overcome grave 
sepsis due to their necrosis, after which the patient bred promptly. 
The complete necrosis and sequestration of the cotyledons in 
retained placenta is not rare in cows. We have observed the 
sloughing off of, so far as we could recognize, all the cotyledons^ 
_the greatly enlarged structures lying in a mass in the uterine 
cavity, still attached to the secundines. Following their re- 



264 Veterinary Obstetrics 

moval and the disinfection of the uterine cavity, fertilization 
occurred in due season. Very frequently, when a retained fetus 
has undergone purulent decomposition and is later removed 
surgicall}^ it is found that the cotyledons are all necrotic and, 
dropping off, are expelled along with, or following, the fetus. 
In due time the cow again conceives. The loss of the cotyledons 
does not lead to sterility ; the septic metritis or other disease 
accompanying the retained placenta may cause sterility by in- 
ducing salpingitis followed by occlusion of the oviducts. Other 
anatomical changes may occur, rendering the patient sterile. 

Our attention is to be directed to measures which may prevent 
the loss of the cotyledons, or, if they have sloughed away, to a 
restoration of the uterus to its normal health. 

9. Vaginitis. 

Though the normal secretions of the vagina are feebl}^ alkaline, 
any disease which may affect this organ and induce purulent or 
other disease discharges tends to change the reaction of these, 
through bacterial influence, and render them acid, a condition 
which is inimical to the life of spermatozoa. It is held that, 
normally, the copulative tract of domestic animals contains more 
or less bacteria, the number and variety being quite abundant in 
the vulva, but decreasing both numerically and in variety as the 
OS uteri is approached. Generalh^ also, it appears that the 
pathogenic power of bacteria diminishes as the os uteri is ap- 
proached so that, in the anterior portions of the vagina, the bac- 
teria present are largely saphrophytic. The bactericidal power 
of the vaginal walls gradually increases toward the anterior ex- 
tremity, to become complete in the normal organ in the cervix 
uteri, beyond which the genital tract is normally free from bac- 
teria. When, however, the copulative tract becomes invaded by 
pathogenic bacteria, their products, coming in contact with the 
spermatozoa, tend to destroy the latter and thus induce sterility 
by the destruction of the male cells before they have reached the 
uterine cavity. 

It therefore becomes essential that, in cases of inflammatory 
disease of the vagina, the infection should first be controlled and 
eliminated before copulation is permitted. Not only should this 
be done from the standpoint of the fertilization of the ovum, but. 



Persistent Hymen 265 

also because of the danger of the transmission of disease to the 
male and, through him, to other females. 

In purulent vaginitis, sterility is the rule, if not constant. 
Perhaps the disease causing the vaginitis itself also involves 
other organs and, independent of the vaginitis, induces sterility. 
So it is with the granular or nodular venereal disease of cows 
and other venereal infections. The handling of these has al- 
ready received consideration on pages 73 to 107. 

During the puerperal period, acute vaginitis may arise, caus- 
ing sterility for the time, or, becoming chronic or leading to adhe- 
sions of the vaginal walls, the sterility may become more or less 
permanently fixed. The overcoming or avoiding of sterility as 
a result of this affection is considered under ' ' Puerperal 
hifcctions.'' 

10. Persistent Hymen. 

As alreadj' stated on page 32, the h3fmen is a membranous 
expansion, stretching across the genital canal between the vulva 
and vagina, and represents the remnant of tissues existing be- 
tween the proctodeal pit and the posterior extremity of the 
embryonic gut. In domesticated animals, this membrane regu- 
larly atrophies and disappears wholly, or nearly so, before birth. 
Exceptionally, it remains until adult life. The persistence is 
most common in the mare, so far as recorded in veterinary 
literature. In a large proportion of cases, the remnants con- 
sist of one or more narrow bands stretching acro,ss the genital 
passage from above to below, not far from the median line. 
The lower end is attached to the vulvo- vaginal boundary just 
anterior to the meatus urinarius and, from that point, slopes 
upward and more or less backward to the roof of the vagina. 

In other cases, the hymen persists to a much greater degree 
and, in one instance, we ob-served a broad sheet stretching from 
above to below and completely closing the left half of the 
vagina. In this mare the hand could be passed along the right 
side of the genital tract until it had reached the vagina and 
then, by causing this organ to balloon, the hymen could be felt as 
a broad membranous expanse about 7 or 8 inches in its perpen- 
dicular diameter and 5 or 6 inches horizontally, the entire 
membrane tensely stretched. 

In another instance we observed a two-year-old filly with the 



266 Veterinary Obstetrics 

hymen persisting entirely across the inferior portion of the 
vagina and extending upward and backward toward the vaginal 
roof, but not reaching it. On attempting to breed the filly, it 
was found that the stallion could not copulate on account of 
some obstruction. As soon as the penis reached the region of 
the hj'men, progress was stopped and the stallion dismounted. 
After several vain attempts at breeding, we were asked to ex- 
amine the filly. We soon discovered that there was an opening 
through the hymen at the superior portion and consequently 
advised the stallion groom to see that the penis was pushed 
upward along the roof of the vagina, b}' the hand. By this 
means, copulation was successful and impregnation took place. 

In other cases which have been recorded in the cow, the 
hymen has completelj' closed the genital passage and caused an 
accumulation of uterine discharges in the vagina. In all such 
cases, copulation is evidently impossible until the membrane is 
ruptured. 

Bands of a similar character are also found, at times, represent- 
ing the embryologic median walls of the fused Miillerian ducts, 
(see page 19) which have failed to atrophy and disappear com- 
pletely, as is normal in the region of the vagina when the ducts 
fuse properly. They may persist so completely as to constitute 
essentially a double vagina. 

In all cases where copulation is interrupted in such a manner 
as we have described, a careful search of the genital canal by the 
veterinarian is demanded. In making this examination one is to 
keep constantly in mind the embrj'ologic development of the 
organs and look carefully for persistent hj'men, which may con- 
stitute a transverse partition, as well as for bands representing 
the persistent median walls of the ducts of Miiller, in the form of 
longitudinal septa. These conditions should always be clearly 
differentiated from anj^ acquired disease or deformityof the parts. 

They are to be handled on general surgical principles and as a 
rule offer but little difficulty in overcoming them. The narrow 
bands representing either of these embryologic structures rarely 
interfere with copulation and it is only when they are quite ex- 
tensive that the process of coition is stopped. They may, as a 
rule, be destroyed by rupturing with the hand or by severing 
with a scalpel. 



Adhesions of the Vaginal Walls 267 

II. Adhesions of the Vaginal Walls. Atresia 
Vagina 

We have already stated on page 95, while describing the 
venereal diseases of the cow, that adhesions sometimes 
occur between the vaginal walls, as a result of these affections. 
This seems to be especially true of the vesicular venereal disease 
in the cow. We have observed one case of adhesion of the vagi- 
nal walls in the mare, but were unable to procure a history of 
the case or otherwise determine its cause. In another instance 
in the mare, the vaginal adhesion resulted from vaginitis follow- 
ing puerperal infection. " 

In all cases of firm, extensive adhesions of the walls of the 
vagina, copulation becomes impossible and more or less serious 
injuries are liable to occur to the female, and possibly also to the 
male, from any attempts at coition. One mare which we ob- 
served was bred to a stallion during estrum and, on account of 
extensive vaginal adhesions, the vagina was somewhat lacerated 
and greatly irritated. The severe irritation caused violent 
straining, which brought about a prolapse of the floor of the 
vagina and, with it, the urinary bladder (vesico-vaginocele). 
This prolapse persisted for some time in spite of all efforts to over- 
come it. At first we attempted to overcome the prolapse by means 
of a rope truss. This failed and we resorted to vulvar sutures, but 
the straining was so violent that they were being torn out and 
were consequently removed, in order to avoid extensive lacera- 
tions. The straining was finally controlled by producing deep 
anaesthesia with chloral hydrate, for a period of four or five 
hours, during which time the local irritation subsided. 

As a general rule, these adhesions of the vagina are beyond 
surgical aid. In handling ca.ses of vaginitis, from whatever cause, 
highly irritant antiseptics, which might injure or destroy the 
external layers of the mucous membrane, should be carefully 
avoided, in order to anticipate such adhesions of the parts, 
which may permanently prevent breeding by making copulation 
impossible. 

12. Vulvar Atresia. 

In some cases of inflammation of the genital tract from vener- 
eal diseases, as well as from traumatic injuries or other diseases 
in the parts, the opening of the vulva may. become so constricted 



268 Veterinary Obstetrics 

as to prevent the entrance of the penis. In one case which we 
observed in a mare, a foal became impacted in the passage during 
the night and remained until the following morning. The pres- 
sure upon the vulva was so great that gangrene of the vulvar 
lips ensued, resulting eventually in such a constriction of the 
vulvar opening that copulation was impossible. 

We maj' rarely be able to overcome such strictures by surgical 
means, but as a rule they are not subject to remedy. The possi- 
bility of such stricture should always be borne in mind in dealing 
with inflammation of, or injuries to, these parts in female breed- 
ing animals. 

13. Horizontal Position of the Vulvar Opening.* 

When breeding females, especially cows and mares, become 
aged and their abdomens enlarged and pendulous, the pelvic 
organs drop forward and downward, and, dragging upon the 
anus and vulva, cause a more or less deep excavation in 
the perineal region. At the same time the posterior dorsal 
and lumbar portions of the spinal column become depressed, 
producing what might be termed senile lordosis, or "sway back." 
The lumbo-sacral articulation becomes involved in the change 
of position of the parts so that it becomes depressed along with 
the sacro-iliac articulation, which brings about a relative eleva- 
tion of the ischiatic tuberosities and a more nearly horizontal 
position of the pelvis. 

These changes in anatomical relations modify the direction of 
the vulvo-vaginal canal so that, instead of the vulvar opening 
being approximately perpendicular, as in the normal, it ap- 
proaches closely to the horizontal. In copulating, the penis 
tends to approach the valvar opening in a direction acutely ob- 
lique, or well nigh perpendicular, to the long axis of the vulvo- 
vaginal canal, thus rendering successful copulation uncertain, 
since the penis tends to glide forward and slightly upward over 
the vulva, against the anus, tail, or other parts. 

We have already drawn attention on page 50 to the danger of 
physical injuries, against which we should guard, but it is also 
important to bear in mind that, whether such injury occur or 



■ Zschokke, die Unfruchtbarkeit des Rindes, page 134. 



Rupture of the Perhieuin and Recto- Vaginal Fistula 269 

not, the abnormal position constantly invites sterility by causing 
a failure in coition. 

The difficulty may be overcome in most cases, and copulation 
rendered safe, by means of standing the female with the posterior 
feet somewhat lower than the anterior and having the male 
stand upon ground approximately level with, or higher than, 
the ground upon which the anterior feet of the female rest. 
This position of the female tends to bring the vulvar opening 
somewhat nearer the perpendicular and consequently renders 
copulation more certain. In the mare, also, the penis of the 
stallion may be largely directed by the groom in a manner to 
avoid accident and render copulation more secure, 

14. Rupture of the Perineum and Recto-Vaginal 
Fistula. 

Rupture of the perineum or of the wall between the rectum 
and the vagina is not rare in the mare as a result of some por- 
tion of the foal, such as the head or a foot, pushing up into the 
rectum and appearing at the anus, while the other parts enter 
the vulva, when, unless prompt relief is given, a few violent ex- 
pulsive efforts on the part of the mare forces the foal out and 
tears the perineum asunder. If the attendance is prompt, the 
misdirected head- or foot may be pushed back into the vagina, 
after it has entered the rectum, and complete rupture of the 
perineum averted, but, as a result of the accident, a fistula gen- 
erally persists, leading from the rectum into the vagina. 

In either case, fecal matter drops from the rectum into the va- 
gina and maintains a constant irritation of the mucosa of the 
vagina, withcatarrhal discharge. 

When the perineum is ruptured, the deformity of the part is 
such that copulation cannot usually be successfully performed, 
and, even if it can be, the presence of fecal matter in the vagina, 
with the consequent inflammation and catarrh, generall}' prevents 
fertilization. 

Sterility due to this cause can only be removed, with any de- 
gree of certainty, by bringing about a recovery from the fistula 
or rupture. In some cases of this kind the sterility may be 
overcome by means of artificial impregnation. The more or less 
befouled vagina may be flushed out with a warm saline solution 
or even with weak antiseptics, after which semen, preferablj' 



270 Veterinary Obstetrics 

obtained from the vagina of a healthy mare immediately after 
copulation, is to be injected into the cervical canal or into the 
uterine cavity of the patient. The question of surgical treat- 
ment of these accidents is discussed under ' ' Accidents of 
Parturition." 

Ill Impediments to Copulation and Fecundation Referable 
to Nervous Disorders. 

1 Excitability and Timidity. In young heifers, especially 
if the animal is verj- timid and is approached by a strange male, 
there is a tendencj^ to avoid coition if possible, although the 
female is properly in estrum. In such instances the behavior of 
the male has much to do with this state and, so far as possible, 
he should be caused to approach the timid animal quietly. 

A mare having a 3'oung foal at her side is sometimes much 
excited and resists the stallion because of the maternal instinct, 
by which she fears some injury to her 5'oung. It is usually de- 
sirable to keep the foal as near as possible to the mare's head, 
where she can see it and recognize its safety. 

2 Vaginismus. In the cow there is occasionally observed a 
peculiar contraction of the vulva, when attempts at copulation 
are made, which is referable to a spasm of the sphincter 
muscles of that organ, due to hypersensitiveness. In this af- 
fection the vulva becomes so firmly closed that the penis of the 
male can not enter and, consequently, copulation can not occur. 
We have seen no records of this difBcultj^ in the mare and have 
observed no cases where copulation failed because of it. In one 
case of nymphomania in a mare we found, upon inserting the 
arm for the purpose of spaying, that the sphincter of the vulva 
contracted so powerfullj' that it caused great pain bj' crushing 
our arm, and so injured it that it was lame for eight or ten hours 
after the operation had been completed. The condition might 
have interfered with copulation. 

Vaginismus is probably most generally connected with ovarian 
disorder. Its cause is to be carefull}' determined by examination. 
If the malady is of ovarian origin, those glands must receive atten- 
tion. If the condition appears to be wholl}^ local, attempts may 
be made to overcome it by inducing fatigue in the animal, by the 
internal administration of narcotics or by the use of local anaes- 
thetics applied to the vulva. 



Extreme Variations in Size 271 

3. Violent Expulsive Efforts Following Coition. In the 

mare and the cow we occasionally observe very violent expul- 
sive efforts immediately following copulation. It is apparently 
due, in some cases, to an irritability of the animal. If there has 
been some pre-existing disease of the part, which has caused a 
stricture of the coital canal, injury may follow the coition which 
produces pain and is naturally accompanied by straining. We 
observe the same results when the penis of the male is compara- 
tively large and the copulation causes laceration or rupture of 
the vagina. It is, consequently, most common in those cases 
where the female is young or is of small size and the male is 
large, and especially where the penis is of very large size or of ex- 
cessive length. In other animals the expulsive efforts are ap- 
parently due entirely to individual irritabilit)'. In such cases, 
immediately following coition, there is severe straining, which 
causes an immediate expulsion of a large part, or all, of the 
semen and may result, according to Zschokke* and others, in 
sterility. 

In all such cases, the cause of the irritation should be discov- 
ered and removed. We have already suggested a plan for pre- 
venting injury from the penis of the stallion under, ' ' The Dangers 
and Infections of Coition ' ' on page 50. We have also pointed out 
the danger of permitting copulation when the vagina is inflamed. 
If the expulsive efforts are due to excessive irritability of the 
animal they may be overcome or ameliorated by causing her to move 
about constantly, or otherwise attracting her attention for some 
time after copulation. 

IV. Extreme Variation in the Size of the Male and Female. 

Under " The Dangers and Infections of Coition," on page 50, 
we have considered the question of the variation in the size of the 
male and female with reference to accidents. Closely allied to 
these accidents is the question of sterility due to this same lack of 
correspondence in size. In all cases where accidents are liable 
to occur because of this difference in size, sterility is likely to 
result for similar reasons. If the female is comparatively either 
too large or too small, sterility may ensue as a result of imperfect 
or incomplete copulation. The nature of the cause suggests the 



*Zschokke, Die Unfruchtbarkeit des Rindes, page 137. 



272 Veterinary Obstetrics 

remedy. Artificial insemination, as described on page 278, may 
be indicated in some cases. 

V. Infectious Diseases. 

Infectious diseases, as a cause of sterility, have already re- 
ceived attention on pages 68 to no. The venereal infections 
naturally tend to produce sterility, though in markedly varying 
degrees. 

In addition to these, there are various infections which tend 
to cause the death of the fetus, and which we shall discuss in 
the chapter upon Abortion. While abortion is not identical 
with sterility, the results of it, by causing the death of the fetus 
prior to its expulsion, are essentially identical, from an economic 
standpoint, with a failure of fertilization itself. 



NOSTRUMS AND PANACEyE AGAINST 
STERILITY. 

Few departments of veterinary practice offer so inviting a field 
for the plying of the sale of nostrums and the application of more 
or less mythical proceedings, as sterility. To the average 
layman, ovulation, fertilization and the development of the 
embryo are as a mysterious sealed book, which gives to the 
quack an open field for plying his method of chicanery. Some- 
times the remedies are not devoid of merit in proper cases, but 
lose their value by being applied uniformly in all cases of sterility, 
regardless of the cause at work in a given case. 

Veterinarians in America indirectly support this chicanery by 
failure to extend scientific aid. Science and charlatanism 
are incompatible and, whenever the veterinarians of breed- 
ing areas study and understand sterility and intelligently 
advise owners of sterile animals, quackery in this respect must 
cease. The veterinarian is helpless in combatting sterilitj' until 
he first learns well the normal structure and functions of the 
genital system ; he must first comprehend fertility ere he can 
understand sterility. Not only does he need have a theoretic 
knowledge of normal breeding, but he must have a clinical 
knowledge. He must be able, by manual exploration, to locate 
and recognize the various internal generative organs In our larger 
domestic animals and to determine by such examination whether 
they be normal or abnormal. This does not come by the reading 
of books nor by making post mortem examinations. The knowl- 
edge does not come to a man in an hour or a day. It is to be 
learned by a conscientious study upon the living animal and 
competency is attained only by long and faithful work. 

When ability has been acquired, and the veterinarian can say 
that an ovarian abcess is present, and speak with authority upon 
the point, the intelligent owner will not resort to nostrums, nor 
cause the os uteri to be dilated. He will not try impregnators 
nor resort to artificial insemination. So, in each case, when the 
veterinarian is able to point out the difficulty with authority, 
the owner will desire the application of a remedy which will 
reasonably tend to remove the cause. As already stated, a pre- 
viously sterile animal may suddenly and unexpectedly conceive. 
i8 273 



274 Veterinary Obstetrics 

Should an alleged remedy have been applied shortly before, it is 
probable that it will be credited with a ciire, though the actual 
cause of the sterility may have been of such a character that the 
remedy applied could in no conceivable way have affected it. 

In addition to many secret nostrums which are placed upon 
the market and vigorously advertised by their promoters, there 
are various remedies, which are not secret, but which have been 
lauded as sovereign against sterility, regardless of the underlying 
cause ; or, possibly, we should say they are regarded as specifics 
against all cases of sterility, the causes of which are unknown to 
the parties concerned. 

Dilation of the Os Uteri. We have already had occasion to 
refer to this procedure while considering "Occlusion of the Os 
Uteri." Dilation of the os uteri has a direct value, and is the 
only scientific method of handling an occlusion of the os uteri 
externum. This much granted, it has been seized upon by many 
as a universal remedy. We have also related that the cervical 
canal of the cow is so narrow, so tortuous, and its raucous mem- 
brane thrown into so many folds, that it is difficult to pass a 
finger or a sound through the canal. This difficulty is made 
greater by the vigorous contraction of the , powerful circular 
mu.scles of the cervix. 

So it is easy to say that the os uteri is closed, much easier for 
a careless veterinarian to make the statement than to prove its 
untruth by passing a sound through into the uterine cavity. 

Of course some females, previously sterile, will breed after 
" opening " the OS, which was not closed: so might the same 
animals have bred had their tails been split, or their horns bored. 

Impregnators. A few years ago there was an an extensive 
interest shown in impregnators as a soverign remedy for sterility 
in mares. Some prominent American practitioners, deeply im- 
pressed with the idea, bent their energies to overcome sterility 
in this manner and devised and patented impregnators of various 
types. Generally they consisted of hollow tubes of soft rubber, 
3 to 4 inches in length, having an opening of variable size, 
usually }4 to }i inch. The outside of the tube was constricted 
in its center, and the posterior end was armed with a broad 
flange to present its falling into the uterine cavity. This ap- 
paratus was inserted in the os uteri externum just before the 
stallion mounted. The theory of use was that the " impregna- 



Nostrums a7id Panacece against Sterility 275 

tor " held the canal open and that, during ejaculation, the semen 
was thrown directlj' into the uterine cavity, the urethal opening 
of the penis coming into direct apposition to the open tube. 

Evidently the os uteri was open, as, otherwise, the " impreg- 
nator " could not have been inserted. The advocates of its use 
have not shown why semen passed through a rubber tube should 
have its virility increased. But mares, which had been sterile pre- 
viously, conceived at the first service, and statements to that ef- 
fect, by owners of mares, were freely used by makers of " im- 
pregnators ' ' to show their infallibility. What influence, if any, 
was exerted by the " impregnator," is not wholly clear, but gen- 
erally it may be regarded as a harmless diversion, which ordina- 
rily will not prevent conception. In rare cases, they may be of 
actual value. 

Incidentally, experience with " impregnators " teaches that, 
contrary to the views of some, the penis of the stallion does not 
enter the cervical canal of the mare during normal copulation. 
If it did, the " impregnator " would inevitably be displaced into 
the uterine cavity. 

Injections of Yeast Solution into the Vagina. Another 
method of handling sterility in cows, which acquired, for a time, 
a favorable reputation, was the injection into the vagina of a 
solution of yeast or the introduction, by other means, of yeast 
into the vaginal cavity. Cows previously sterile, in some cases, 
promptly conceived and these cases were naturally reported. 
Those which did not conceive after the treatment were generally 
not mentioned. 

There may be conditions of the vagina, chronic infections of 
the mucosa, or other disease, which the application of yeast may 
overcome, but this has not been determined. It is inconceivable, 
in our pre,seut state of knowledge, that yeast introduced into the 
vagina could overcome c}'stic degeneration, sclerosis or abscess 
of. the ovaries, or, indeed, many of the conditions named in the 
preceding pages as causes of sterility. 

Aphrodisiacs. Yohimbin Spiegel. For many years 
numerous drugs have been credited with the power of arousing 
the sexual appetite and, through this agency, the sexual powers. 
Among these drugs are : cantharides, turpentine and the balsams 
and resins and, more recently, a new drug, yohimbin, has been 



276 , Veterinary Obstetrics 

introduced to overcome sterility. In large doses, these drugs 
induce more or less irritation of the urino-genital tract and 
stimulation of the sexual desire. 

To what extent aphrodisiacs stimulate ovulation and spermato- 
genesis has not been determined. It is possible that indirectly, 
through irritation of the genital-tract, they stimulate the ripen- 
ing and discharge of ova and spermatozoa but, from all data at 
hand, they merely arouse the sexual appetite without increasing 
the sexual powers. In the minds of some, vigorous sexual 
desire signifies exalted breeding powers, but this is a false 
assumption. In nymphomania, for example, the sexual appe- 
tite is intense and the breeding power almost nil. Sexual ap- 
petite, without normal ovulation in the female and the forma- 
tion of normal spermatozoa in the male, has no value for breed- 
ing purposes, but is rather a harm, frequently leading the owner 
astray and diminishing the value of the patient for other 
purposes. 

Yohimbin has recently acquired a high repute, in some quar- 
ters, as a remedy against sterilit}?, both in human and in veterinary 
practice. It has been commended chiefly for arousing the 
sexual appetite, when absent in either sex. Its efficacy is in 
vigorous controversy and the cost of the drug is at present pro- 
hibitive except in unusually valuable animals. 

Holterbach (Berlin Tierarztliche Wochenschrift, No. 9, 1908), 
in an exhaustive article, champions the use of the drug. 

He used the drug in 37 cases of absence of sexual desire : 
22 cows, 9 bitches, 3 bulls and 3 sows. In his observation, the 
drug has a greater affinity for the female than for the male 
genitalia. A five year old Simmerthal cow calved normally in 
June, 1906, but estrum did not follow. All other drugs, in- 
cluding cantharides, proved useless. In August, 1907, 14 
months after calving, 16 tablets of yohimbin chlorid, each con- 
taining 0.1 gram of the alkaloid, were prescribed, one tablet .to 
be given three times daily in the drinking water. On the third 
day there was excitement, bellowing, uneasy stepping about, 
frequent urination and decreased milk flow. On the fourth day 
there was a muco-sanguineous discharge from the vulva 
(menstruation?) and on the fifth day the owner noted expulsive 
efforts resembling labor pains. The external genitals were 



Nostrums and Panacea; against Sterility 277 

swollen and hyperaemic, but no estrum was present. The 
uterus was large. The ovaries were enlarged, but not cystic. 
Six weeks later, the cow, showing violent estrum, was bred and 
the owner " believed " her in calf. 

Another cow, nine months post partum, without estrum, and 
having cystic ovaries, was treated in the same way, developed 
estrum 10 weeks later, was bred and the owner " believed " her 
to be pregnant. 

Frubinger (D. M. W. No. 7, 1907) condemns the drug as 
worthless and attributes the alleged cures in man to suggestion. 

Miiller (Arch. Internat. Phar. et de Therap. Vol. XVII, p. 
81) considers it an erratic aphrodisiac, acting differently on 
different individuals. Daels, quoted by Holterbach, experi- 
mentally caused menstruation in a bitch already in estrum, but 
bitches usually menstruate at this time anyhow. In another, 
not in estrum, but date of probable normal estrum not named, 
menstruation occurred in four days. A third bitch showed a 
mucous discharge. Later, bloody feces were voided and the 
animal died from the toxic effects of the drug. Autopsy .showed 
enlarged, congested genital canals, prominent ripe ova, etc. 

In experiments with young bitches, less than nine months 
old, the drug, in fatal toxic doses, failed to cause reactions in 
the genital organs. 

So far as we have been able to determine, the drug has not 
induced estrum in any case where estrum may not have occured 
without it, nor impregnation where such a result was not per- 
fectly possible without the drug. 

The alleged estrum induced was of doubtful character. Swell- 
ing of the vulva occurs without estrum. A bloody discharge 
from the vulva may not be menstruation. The bloody feces 
following the administration of the drug might be called men- 
struation with equal right. 

Further authentic data are essential to a reliable conclusion. 
Until these are at hand, the administration of the drug should 
be regarded as a very expensive experiment of exceedingly 
doubtful value. It has a possible value in cases where sterility 
exists as a consequence of the absence of sexual desire without 
organic disease of the genital glands. 



ARTIFICIAL IMPREGNATION. 

Undoubtedly efficient in some cases, artificial insemination has 
been advocated as a widely applicable remedy for sterilitj-, ap- 
parently upon the theory that sterility is usually based upon 
mechanical impediment. 

Artificial insemination is an easy and successful operation in 
fertile mares and other females with readily penetrable os uteri. 
It is difficult of application in the cow because of the narrow, 
tortuous, obstructed cervical canal. It is a valuable remedy in 
cases due to physical impediments to natural insemination, in so 
far as obstacles are surmountable by this means. It is incon- 
ceivable, in the present state of our knowledge, how the opera- 
tion can otherwise exert a favorable influence upon sterility, 
unless we admit that in some cases, owing to nervous causes, 
insemination without copulation, by avoiding the nerve- reflexes 
of that act, may favor fertilization. This has not been shown. 
Some exaggerated statements have been made regarding its 
efficiency. It has been asserted that 50 %, 60 %, or more, of 
mares, taken in large numbers, regardless of the presence, near- 
ness or remoteness of estrum, will be fertilized by this process. 
Upon its face, the contention is absurd. There is a belief, to 
which some embrj'ologists have lent weight, that spermatozoa 
will live for days and weeks in the genital tube awaiting the ap- 
pearance of an ovum. We have found no convincing data, how- 
ever, to indicate that, in a fertile animal, coming regularly in 
estrum and artificially inseminated shortly after a normal estrual 
period, the spermatozoa have remained in the genital canal until 
the next ovulation and induced fertilization. If the mares are 
fertile and the artificial insemination is carefully made at the 
proper time in relation to ovulation, there is no reason to doubt 
that 60 % or 100 % may be fertilized. 

In occlusion of the cervical canal, in deformities and defects of 
the OS uteri, which may inhibit or render uncertain the passage 
of the spermatozoa into the uterine cavity, artificial insemination 
constitutes a rational and valuable remedy. In some diseases of 
the vagina and of the vaginal portion of the uterus, artificial 
insemination offers possibilities which should not be ignored. 
In recto-vaginal fistula and in rupture of the perineum, where 



Artificial Iinpregnation 279 

copulation is rendered difficult or uncertain, the operation is in- 
dicated. The limitations of artificial impregnation as a remedy 
against sterility should be fully recognized, and the value of the 
process should not be discredited by its application in improper 
cases. 

It has been urged, and with some rea.son, in cases of deformity 
of the penis in stallions, by which the semen is ejaculated in 
some other direction than forwards, that the fertility of the male 
may be greatly heightened by artificial insemination added to 
the imperfect copulation. 

There is a connnercial feature, in connection with artificial in- 
semination, which interests the breeder rather than the veterin- 
arian and has no relation to sterility. Throughout nature there 
is a superabundance of male fecundating cells. In a normal ejac- 
ulation of a healthy adult male, there are sufficient spermatozoa 
to fecundate innumerable females. It has, consequently, been 
proposed to extend the procreative power of a valuable breeding^ 
male by artificial insemination — by collecting some of the semen 
from the vagina of the female just served and transferring it, un- 
der proper precautions, to the vaginae of other females, to cause 
one copulation to answer for several or many fertilizations. 

The operation of artificial insemination is simple. It may be 
practiced as an adjunct to copulation. In such case, the male is- 
permitted to serve the female, and promptly thereafter the 
operator inserts his hand into the vagina, picks up some of the 
semen and introduces it into the cervical canal. This may be 
done with the aid of a short spoon, in which the semen may be 
picked up and inserted through the os. A syringe, of almost 
any type, may be used to pick up the semen and then inject it 
into the uterus. The operator may simply use his hand. Even 
one finger immersed in the seminal fluid and pushed into the 
cervical canal would, ordiuarily, carr}' sufficient spermatozoa to 
accomplish the purpose. This plan of insemination is applicable 
in those cases where some physical hindrance to natural insemi- 
nation exists, of a character surmountable by the artificial method. 

A second method of artificial insemination is the transfer of 
the semen from the vagina of a female, with which the male has- 
recently copulated, to another female. If the two females are 



28o Veterinary Obstetrics 

in close proximity, the operation is readily carried out by means 
of any of the impregnation syringes, or otherwise. It is essen- 
tial merely that the transfer be made promptly and without se- 
rious damage to the seminal fluid. 

By this method, females incapable of copulation may be im- 
pregnated, such as those suffering from ruptured perineum or 
other obstructions in the vagina or vulva. It may also be re- 
sorted to in order to avoid the dangers of copulation between 
animals in which there is too gross a variation in size, either the 
male or the female being too large to safely copulate with the 
desired mate. 

The chief essentials in artificial insemination are cleanliness 
(asepsis), reasonable promptness, the protection of the semen 
against extremes of temperature and its secure lodgment in the 
uterus or cervical canal. 

The hands, vessels and apparatus are to be made clean — asep- 
tically clean — and every precaution taken against the transfer 
of dangerous infection. The possibilities of transferring infec- 
tious diseases by this means should not be underestimated. 

The duration of the vitality of the spermatozoa has not been 
full}' determined. They can be kept alive in a warm saline so- 
lution for days, but it is doubtful if their fertilizing power can 
be maintained, with practical certainty, for a long period of time. 
The transfer should consequently, in the interests of efficiency, 
be made as promptly as possible. While, experimentally, artifi- 
cial fertilization ma^' be induced after carrying the semen a long 
distance and keeping it many hours, the intervening time sub- 
jects it to many unfavorable circumstances. If to be carried, it 
may be placed in a rubber bag or wide mouthed bottle, the ves- 
sel being immersed in water at a temperature of about loo ° F. 
and maintained at about this temperature until the semen has 
been used. 



EMBRYOLOGY. SEGMENTATION OF THE EGG 

We have already suggested in a preceding chapter that fertili- 
zation of the egg, under normal conditions, occurs in the 
oviduct, immediately after the rupture of the ovisac and the 
discharge of the egg into the tube. The observations upon this 
point have been carried out largely upon the rabbit as a repre- 
sentative of mammalia and it is assumed that the phenomena oc- 
curring in this animal are largely typical of the entire mammalian 
group. In the observations upon fertilization in the rabbit, cop- 
ulation has generally ensued immediately after the doe has given 
birth to young and from 8-12 hours prior to the rupture of the 
Graafian follicles. Under these conditions, when the ovisacs rup- 
ture, the spermatozoa have already passed through the uterus and 
the oviduct and have reached the ampulla of the tube, so the^^ may 
at once meet the egg when it is discharged and fertilization im- 
mediately follow. The spermatozoa may even have reached the 
ovum while yet in the ruptured ovisac, before its discharge into 
the Fallopian tube as shown in Fig. 20. 





Fig. 20. A fully formed ovum of the Rabbit shortly before its discharge 
fromi the ovary. Marshall after Bischoff. 

Fig. 21. Ovum of Rabbit from the upper end of the oviduct after ex- 
trusion of the two polar bodies. Marshall after Bischoff. 

MO, Spermatozoon. N, nucleus or germinal vesicle. NU, Nucleolus or 
germinal spot. PB, Polar bodies. Z, zona radiata. 

This rule is probably true in our larger domestic animals, but 
it is possible that copulation may sometimes be delayed until 
after the rupture of the ovisac and the discharge of the ovum 
into the tube so that, before it meets with the spermatozoa, it 



282 Veterinary Obstetrics 

va&y have travelled some distance along the oviduct toward the 
uterus. 

In the typical fertilization of the ovum in the rabbit, where 
the spermatozoa have already reached the anterior end of the 
oviduct when the Graafian follicle ruptures, the ovum undergoes 
segmentation or division during its passage toward the uterus. 
According to Van Beneden, the segmentation of the ovum begins 
lo or 12 hours after fertilization or 18-24 hours after copulation 
and continues for the next two days or until about the end of 
the third day, at which time the ovum reaches the uterus and 
its segmentation has been completed. At this time it is about 
the same size as the original ovum or possibly somewhat smaller, 
but has acquired, during its passage through the oviduct, a layer 
of albumen on its exterior, which increases the total size very 
considerabl}'. 




Fig. 22. A rabit's ovum from the middle of the length of the oviduct, 
about 22 hours after copulation, showing division of the ovum into two- 
cells. X 200. Marshall after Bischoflf. 

CB, Blastomere, or segmentation cell, MO, Spermatozoon imbedded in the 
zona radiata. N, Nucleus. Z, Zona radiata. 

The length of the time required for the passage of the ovum 
from the ovary to the uterus has not been determined for most 
animals, but, reasoning from other data in embryology, it 
would appear possible that, in the larger animals, it may require 
a longer period of time for travelling through the tube than in 
small ones like the rabbit. If we are to judge of the time re- 
quired for the passage of the ovum through the oviduct by the 
appearance of estrum and menstruation, we would be led to assume 
that, in the cow, it is quite as rapid as in the rabbit. Some 



Segtnentation of the Egg 



283 



authors estimate that in woman the period is probably five to 
eight days, but we are aware of no definite data upon which to 
base this assumption. 

About 10-12 hours after the fertilization of the egg of the 
rabbit, the ovum undergoes cleavage, by which there arise two 
spherical cells, which are essentially alike in all respects except 
that some observers believe that the one is slightl}^ smaller than 
the other. See Fig. 22. 

Each of these two cells, after a brief pause of a few hours, 
divides again into two cells, constituting a mass of 4 ovoid cells, 
which again subdivide to constitute a group of 8 cells, those de- 
rived from the larger of the two first cells being now more clearly 
larger than the others, the larger ones grouped together cen- 
trally, while the smaller rest upon them as a cap. Later the 
segmentation of the small cells proceeds somewhat more rapidly 
than that of the larger and they tend to grow around and enclose 
the latter. According to Marshall, when the ovum of the rabbit 





Fig. 23. A rabit's ovum from the lower end of the oviduct, about the 
middle of the third day ; showing the morula stage, shortly before the 
completion of segmentation. X200. Marshall after Bishoff. 
Fig. 24. A rabbit's ovum seventy hours after copulation, taken from the 
lower end of the oviduct just before entering the uterus and showing the 
condition at the close of segmentation. X 200. Marshall after Van- 
Beneden. 
has reached the 70th hour after fertilization, its segmentation 
has been completed and it passes from the oviduct into the uterus. 
At this time it is a spherical mass consisting of an exterior layer 
of small, nearly spherical, transparent cells, enclosing almost 
completely the group of larger, more granular cells ; it has 
reached what is known as the morula or mulberry stage. See 
Figs. 23 and 24. 



284 Veterinary Obstetrics 

At this stage the external layer, consisting of the smaller cells, 
and the internal mass of larger ones are firmly attached to each 
other at one point only. The segmented ovum is still surrounded 
by the vitelline membrane, the zona radiata and the layer of al- 
bumen which it had acquired during its progress through the 
oviduct. 

Within a few hours after entering the uterus the ovum has be- 
come greatly enlarged, owing to the accumulation of a fluid be- 
tween the external laj^er of small cells and the mass of larger in- 
ner cells, except at the point of attachment between the two, so 
that the inner mass occupies a comparatively small area at the 
superior pole of the ovum. This stage in the development of 
the ovum is known as the blastodermic vesicle. The vesicle con- 
sists of an outer wall of flattened, polygonal cells, which have 
been formed from the outer cells of the previous stages, to which 
is attached, at one of its poles, the small mass of large cells. 
Separating the two layers of cells, except at the polar point of at- 
tachment, is a relatively large quantity of fluid, which greatly dis- 
tends and increases the size of the vesicle. The mass of inner 
cells is flattened out in the form of a disk, consisting of several 
layers of somewhat spherical cells at the center, which is known 
as the embryonal or germinal area, while, at the pheriphery, 
they are but one or two layers in thickness. As the vesicle in- 
creases rapidly in size the vitelline membrane disappears, while 
the zona radiata and the albuminous layer become greatly at- 
tenuated by being stretched out. 

During this stage of development, which continues in the rab- 
bit to about the seventh day, the ovum lies free within the uter- 
ine cavity and, in case of multiparous animals, the ova, which 
enter the uterus almost simultaneously, tend to distribute them- 
selves at more or less uniform distances apart throughout the or- 
gan and assume the positions which they are to retain through- 
out their period of intra-uterine development, the location of 
each being early indicated by a bulging of the uterine walls. 

Germinal Layers. 

Toward the close of the developement of the blastoderm, im- 
portant changes take place, by which there are established three 
distinct germinal layers, each of which is destined to take a spe- 



The Primative Streak. The Primative Groove 285 

cial part in the formation of certain tissues of the embryo. These 
changes affect chiefly the embryonal area or that point in the 
blastoderm at which the various layers are united, and the inter- 
nal cells are massed. 

The exact method of tlie formation of the germinal layers is 
not wholly free from controversy. In the embryonal area, which 
is a circular or discoid patch, three layers of cells may be recog- 
nized : an upper or external layer of pavement cells, the epiblast ; 
a middle layer of larger, cuboidal cells, the mesoblast ; and a 
lower stratum of pavement cells, the hypoblast. 

At the margin of the embryonal area, the walls of the blas- 
todermic vesicle consist of two layers of cells representing the 
external and internal germinal layers, while, passing slightly be- 
yond this, the remainder of the blastodermic vesicle, constituting 
about %' of its total surface, consists of a single layer of cells, the 
epiblast. 

According to Rauber and KoUiker, the uppermost layer of the 
blastodermic vesicle, the primitive epiblast, disappears from the 
embryonal area, to be succeeded by a new epiblast arising from 
the mesoblast so that, according to these, the entire embryonal 
area is ultimately derived from the inner hypoblast, which, in 
the morula, consisted of the larger, granular, slowly multiplying 
mass of cells. 

Late in the blastodermic stage, the embryonal area becomes 
pyriform, its greater diameter corresponding to the long axis of 
the blastodermic vesicle, which has now assumed the eliptical 
form. The broader end of the embryonal area may be desig- 
nated the anterior, or head, end and the narrower the posterior, 
or tail, end. 

The Primitive Streak. The Primitive Groove 

As the blastodermic vesicle approaches the completion of its 
development, there appears the primitive streak, consisting of an 
axial thickening of the epiblast, at the posterior, or tail, end of 
the embryonal area. This thickening extends longitudinally 
and finally equals about two-thirds of the length of the area and 
has a faint longitudinal depression known as the p7'imitive groove. 
A cross-section of the primitive streak shows it to consist of a 
multiplication of the deeper cells of the epiblast on the median 



286 



Veterinary Obstetrics 



line. From the deeper layers of this thickened, dense, primitive 
streak, the cells grow out in lateral plates between the epiblast 
and hypoblast, to constitute the permanent mesoblast. See 
Fig- 25. 




Fig. 25. A transverse section across the hinder part of the em- 
bryonal area of a rabbit embryo at the end of the seventh day, 
the section passing through the primitive streak. X 80 Mar- 
shall after Kolliker. 

E, Epiblast. H, Hypoblast. M, Mesoblast. 

PG, Primitive groove. PS, Primitive streak. 

Formation of the Embryo 

The embryo is formed in the embryonal, or germinal, area. A 
longitudinal depression known as the neural groove is formed 
immediately in front of the primitive streak, the long axes of the 
two structures being parallel. The neural groove is bordered on 
the sides by the neural folds, which grow upward from the epi- 
blast and then approach each other to become united into a tube, 
in which, eventuall}', the central nervous system is formed and 
soon shows, in its anterior or head-end, the brain vesicles. 

By an infolding of the walls of the blastodermic vesicle about 
the margins of the embryonic area, the latter becomes con- 
stricted oif from the rest of the vesicle, which then constitutes 
the vitelline, or yolk sack. The yolk sack of the mammalian 
embryo is small and of little consequence, as it contains no ap- 
preciable amount of nutriment for the embryo, but simply a 
quantity of a presumably inert fluid. After this constriction 
forms, dividing the embryo from the yolk sac, the dorsal surface 
of the embryo grows much more rapidly than the ventral, which 
causes it to bend ventralwards very rapidly, so that the head-end 
is soon at right angles to the remainder of the embryo. The 
head-end of the embryo, by becoming flexed, is bent downward 



The Ccelom or Body Cavity 287 

into the yolk sac and pushes the walls of the latter before it. 
The different parts of the brain soon become recognizable and 
the nose, ej'es and ears are also quite apparent, while, upon the 
sides of the head and neck, the visceral arches and clefts are 
seen. 

The Ccelom or Body Cavity 

On the eighth or ninth day after fertilization in small animals, 
perhaps somewhat later in the larger ones, the ccelom, or body 
cavity, is formed as a cleft or rearrangement of the cells of the 
mesoblast, by which an extensive cavity is formed, radiating 
outwards from the region of the notocord, to pass beyond the 
embryo itself and extend outward in the walls of the blastoderm 
to near the margin of the mesoblastic area. This change serves 
to divide the mesoblast into two layers, the external of which is 
closely adherent to the epiblast, the two constituting the somata- 
pleur, while the inner mesoblastic layer and the endoblast, with 
which it is intimately related, constitute the splanchnopleur. 

From the epiblast arise finally the epidermis, the hair, nails, 
hoof, horns, etc., and the cerebro-spinal nervous system. From 
the mesoblast arise the muscles, bones, connective and other 
skeletal tissues and the deeper layers of the skin. 

The mesoblast of the splanchnopleur gives origin to the heart 
and the muscular portions of the digestive, respiratory and urino- 
genital organs and, in a general way, to the pale, or unstriped, 
muscle fibers, while the somatopleuric mesoblast forms the 
striped, or voluntary, muscles. The endoblast of the splanchno- 
pleur forms the epithelium of the digestive and respiratory tracts. 
The origin of the various tissues from the three embryonic layers 
is of great interest in the study of medicine and surgery and 
numerous functions can only be understood by recalling the em- 
bryonic origin of certain tissues in the adult. A wound of the 
epithelium can be repaired by epithelial tissues only. Cells 
originating from the mesoblast have not the power to repair the 
epiblastic injury. 

Ere the blastoderm can proceed far in its development, new 
provision must be made for its nutrition, which, in mammalia, 
must be derived from the mother through an intimate relation 
between her uterine mucosa and special organs of the fetus, 
the fetal envelops, especially the placenta. 



288 Veterinary Obstetrics 

At a very earl}^ period, this nutritive relationship between the 
mother and the fertilized ovum is established by two outgrowths: 
one of the extra-embryonal somatopleur, to constitute the am- 
nion ; the other from thesplanchnopleur, to constitute the allan- 
tois, both of which we shall describe later. 

The Nervous System 

We have already intimated that the neural g^-oove of the blas- 
toderm marks the beginning, location and direction of the future 
cerebro-spinal nervous system. Consisting of thickened epiblast, 
the neural folds increase in prominence, while the groove between 
them deepens and the summits of the folds approach each other 
as segments of an arch, to finally meet and fuse above the groove, 
converting it into a closed tube which, lined with ciliated epi- 
blastic cells and filled with fluid, is to persist throughout the life 
of the animal as the central canal in the spinal cord and as the 
ventricles of the brain, while, from the deeper epiblastic cells in 
the walls of the tube, are to develop the nerve cells and fibers of 
the cerebro-spinal axis. Under normal conditions, the neural 
groove grows rapidly in length and depth and, in the rabbit, its 
lips have met and fused to constitute a complete tube by the end 
of the ninth day. At this time one can distinguish the spinal 
cord, the fore-brain, the mid-brain and the hind-brain. 

The cerebro-spinal nervous system of mammalian animals con- 
stitutes the central organ, about which the other portions of the 
embryo develop in more or less complete harmony. Any inter- 
ruption in the normal development of the cerebro-spinal axis in- 
terrupts or vitiates the proper growth of other parts of the body. 
Should the neural groove become branched and double at its 
anterior end, there forms in the embryo two heads instead of one, 
constituting a double-headed monster or bicephalus ; (See Fig. 35) 
or the fission may extend more posteriorly to constitute double 
neck or chest. Should the posterior end of the neural groove 
undergo division into two parts, we have a monster in which 
the posterior parts of the body are double, while the anterior 
may remain single and normal. Should two neural grooves form 
side by side and in intimate contact with each other, there 
may result a double monster, of two more or less separate 
bodies as in Figs. 126 and 127. Finally, the division 
between the two neural grooves may be complete and two^ 



The Nervous System 289 

embryos form which are wholly separate, but have common en- 
velops and umbilic cords. In the cow not rarely we find one of 
the two embryos so aberrant in form as to constitute a well nigh 
shapeless mass like Figs. 26 and 27, known as amorphics, 
acardia, or a " mole. ' ' 




Fig. 26. "Mole," or Acardia. From Cow. 
M, Muzzle. SM, SM, Superior maxilla, showing white denticles. 
IM, IM, Inferior maxilla showing denticular masses (grinders). 
BM, Buccal mucosa showing papilla. 
T, Tongue. I, Incisors. 
One-half size. 

The fusion of the lips of the neural canal maj' become inter- 
rupted at various points and the canal may remain open even to 
the time of birth, to constitute spinal bifida. An instance of 
this occurring in the dorsal region (dorsal spinal bifida) is shown 
in Fig. 28, in which the superior wall of the spinal canal is want- 
ing from the dorsal region, backward. A similar persistence of 
the neural groove may occur at any point in its entire length, 
producing cervical, dorsal, lumbar or sacral spinal bifida, accord- 
ing to location. 
19 



290 



Veterinary Obstetrics 

L 




Fig. 27. Sagittal Section of Fig. 26. 

I, Incisors. T, Tongue. M, Muzzle. 

B, Bone (skull?). B', Bone (slernum?). B^, Bone (pelvis?). 

L, Lung. R. Rumen and reticuluqj. 

U, Umbilicus. O, Omasum. 

One-half size. 




Fig. 28. Spina Bifida with Spinai< Flexure. 

CV, CV, Cervical vertebrae. R, ribs. 
SC, Spinal corii ending in anterior dorsal region. 
DLV, Dorso-lumbar vertebra. S, Sacrum. 
IPS, Iscbio-pubic symphysis. 



The Brain 



291 



The Brain. 

The brain commences to form and is recognizable before the 
neural canal has been completed. It consists at first chiefly of a 
series of vesicles which are known as the fore-brain, mid-brain, 
and hind-brain. The anterior cerebral vesicle, or fore-brain, gives 
rise very early in its development to the optic vesicles, as lateral 
outgrowths, which are ultimately converted into the essential 
parts of the eye. ' 

Normally, there are two of these outgrowths, which, under 
aberration in development, may fuse or grow out as single pro- 
jections on the median line, to constitute the one-eyed monster, 



r_}^- MP 




4- SM 



, IM 



P'lG. 29. Skoi.!:, of Cyci,ops. Foal. 

Oc, Occiput. O, Single orbital cavity. 

MP, Coronoid process of inferior maxilla. 

SM, Superior grinders. 

SI, Superior incisors fused into a single organ. 

IM, Inferior grinders. T, Tongue. 

II, Inferior incisors. 



292 Veterhiary Obstetrics 

or Cyclops. In case of this fusion of the optic vesicles, the de- 
velopment of a single vesicle on the median line, there is a ten- 
dency towards the inhibition of the development of the olfactory 
vesicles. 




Fig. 30. Cyci,ops. Lamb. 
A, Head and neck, seen from below. B, Sagittal section. 
M, Mouth. Ea, Ear. 

N, Nostril. P, Dilated pharynx. ON, Olfactory' nerve. 
OpN, Optic nerve. Ep, Epiglottis. O, Oesophagus. 



The Brai7i 



293 



The cerebral hemispheres are developed first as a median pro- 
longation at the anterior end of the fore-brain, which later be- 
comes divided into the two hemispheres bj' its anterior wall 
growing back into it from the front. These two hemispheres 
appear first as large vesicles with ver}' thin walls and these cavi- 
ties persist throughout life as the lateral ventricles of the brain 
which communicate, through the foramina of Munro, with the 
third ventricle. See Figs. 41 and 60. 




Fig. 31. Hydrocephai,us. C.\lf. ( After photograph ) . 

In some cases the fluid in these cerebral hemispheres becomes 
enormously increased, to constitute the fetal disease of hydro- 
cephalus as indicated in Fig. 31. In other instances the cerebral 



294 



Veterinary Obstetrics 



hemispheres grow rapidly and the walls of the skull fail to close 
over them, so that they protrude, to constitute hernia cerebri, as 
shown in Fig. 32. 

From these cerebral hemispheres, there grow out early in their 
development the olfactory vesicles, which are later to develop 
into the olfactory lobes, from which the olfactory nerves pass to 
the nose. These sometimes fail to appear if the optic vesicles are 
represented by a single vesicle, to constitute a cyclopean monstros- 
ity as shown in Figs. 29 and 30. 




Fig. 32. Hernia Cerebri. Pig. 

Lateral view of brain, seen from the left. 

A, Segment of skin covering the herniated portion of the brain, B. 

CC, Cerebrum. D, Cerebellum. E, Medulla oblongata. 



The SpiNi^L Cord. 

As already suggested, the spinal cord develops from the pos- 
terior portion of the neural groove. The neural folds grow up- 
ward and their borders approach each other, to finally fuse at 
their margins, leaving a cavity within, which constitutes the 
central cavity of the spinal cord, and persists throughout the 
life of the animal. The neural canal is lined bj' columnar, cili- 
ated epithelium which persists throughout life, to constitute the 
epithelium of the central canal. The deeper layers of epithe- 



The Spinal Cord 295 

Hum about the spinal canal go to form the skeletal frame- work and 
the nerve cells grow out into these deeper parts from the col- 
umnar epithelium which lines the cavity. These nerve cells, 
or neuroblasts, are at first spheroidal in form and show upon 
their surface one to several prolongations, which are later to 
constitute the polar elongations, or axis cylinders, of the nerves. 
The spinal nerves develop first by the formation of the spinal 
ganglia, which appear in the neural folds at a very early period, 
and from the inner sides of which there grow out nerve fibers 
into the spinal cord, to constitute the superior, or dorsal, roots of 
the spinal nerves. They become the centripetal, or sensory, 
roots of the nerves. The ventral, or motor, nerves arise very 
early as small outgrowths from the lower part of the sides of the 
spinal cord, in the position they occupy during adult life. These 
ventral roots grow outward to meet the dorsal roots just beyond 
the ganglia and fuse with them, after which they again divide 
into dorsal and ventral twigs, which are mixed nerves. 



DEVELOPMENT OF THE ORGANS OF SPECIAL SENSE 
A The Olfactory Organs. 

The Nose. 

The olfactory organs appear early in embryonic life as thick- 
ened patches of epiblast upon the antero-inferior part of the 
head, which patches soon sink inwards to constitute the olfactory 
pits, into the bottom of which the nerves of smell grow out from 
the olfactory bulbs of the brain. 




Fig. 33. The under surface of the head of a human embryo, let- 
tered by Professor His, Hn, and estimated as about twenty-nine 
daj'S old. X 7J4. From Marshall after His. 

BS, Cerebral hemisphere. DS, Stomatodeum. FO, Processus 
globularis, or lateral portion of fronto-nasal process. HM, hyo- 
mandibular cleft. MN, Mandibular arch. MX, Maxillary arch. 
OC, Eye. OK, Olfactory pit. 

The olfactor}' pits are at first incomplete, their lower borders 
being deeply notched, and communicate with the stomatodeum, 
somewhat as an extension of that cavit}'. The olfactory pits 
and the stomatodeum are connected bj^ a narrow isthmus, 
bordered inwardly by \hs. processus globulares of the fronto-nasal 
process and externallj' by the maxillary processes of the maxillary 
arch. Soon the maxillary processes approach and fuse with the 
processus globulares anteriorly, to complete the circumference 
of the olfactory pits and, by separating them from the mouth, to 
constitute the nostrils. For a short distance anteriorly, as 
far as to the incisive foramen of the adult, the processus globulares 
send projections inwards to constitute the anterior portion of 
the palate, while, behind the foramen, the maxillary processes 
send out shelf-like projections, which meet on the median line to 
296 



The Olfadoiy 0?'gans 



297 



constitute the posterior portion of the palate and, from their fus- 
ing borders, seud projections upward to eventually reach and fuse 
with the lower surface of the fronto-nasal process, to constitute 
the nasal septum, dividing the nasal chamber into two distinct 
cavities. The nasal passages are at first very short but, as the 




Fig. 34. ScHisTocEPHAi,us BiFiDus. (Gurlt 



nose elongates, the palatine processes from the maxillary arch 
grow backward and, fusing on the median line, completely separ- 
ate the oral and nasal cavities so that the latter finally open 
posteriorly, through the posterior nares, into the pharynx. 

The upper lip is formed by a fusion of the fronto-nasal pro- 
cesses with the maxillary arch. Aberrations in the development 
of the anterior nares and upper lip are not rare, especially in bo- 
vidae, where, in some instances, the processus globulares fail to 
fuse with the maxillary processes, constituting hair lip (Schisto- 
cephalus fissilabrus). In other instances as in Fig, 34, fis- 
sion on the median line through the fronto-nasal process occurs, 
so that the maxilla is divided, with the mandible curved up- 



298 



Veterinary Obstetrics 



ward between the two lateral halves, to constitute schistoceph- 
alus bifidus. 

In dealing with diseases of the septum nasi, its origin should 
always be recalled and it should be remembered that, in some 
forms of disease, fluids may collect or new tissues may develop be- 
tween the two laminae, from which the septum takes its origin. 




Fig. 35. Cleft PalaTK. Foal. (From photograph). 

In some cases these margins fail to fuse and result in a cleft 
palate, as shown in Fig. 35. In other instances the fusion ex- 
tends too far backward and, passing across the pharynx, com- 
pletely separates the nasal chamber from the mouth and pharynx, 
constituting atresia of the posterior nares, by which arrest in 
development the animal is unable to breathe through the nostrils 
and must respire entirely through the mouth. With the greatly 
elongated soft palate of the horse, which renders oral breathing 
extremely difficult, the animal can not live if both posterior nares are 
closed, while, if the atresia affects but one nostril, the animal, 
can breathe readily when not severely exerted, but, if put to 
hard work, shows extreme dyspnoea as a result of the restricted 
breathing room. 

The Eye. 

The eyes originate partly from the optic vesicles of the brain 
and partly from the optic pits in the epiblast upon the sides of 
the head. 

The optic nerve develops from the optic vesicles, which ap- 
pear as lateral outgrowths of the fore-brain early during em- 



The Eye 299 

bryonic life, varying apparently in species from 10-20 days after 
fertilization. The optic vesicles appear first as tubular out- 
growths from the forebrain, but the distal end of each soon becomes 
enlarged, while the connecting stalk remains a narrow tube. Later, 
the enlarged distal end becomes invaginated within itself to con- 
stitute the optic cup, which is later to form the retina and within 
which the vitreous body develops. The lens develops somewhat 
later, first appearing as a pit in the epiblast upon the side of the 
head. This pit gradually sinks deeper and its mouth narrows, 
until it finally closes to constitute the vesicle of the lens. 

The vesicle sinks into the optic cup and the margins of the latter 
come in close contact with it except at one point on the ventral 
surface, where there is a distinct groove, the choi'oidal fissure. 
Within the vesicle the lens becomes elaborated from the enclosed 
epiblastic cells. 

The vitreous body is derived from an ingrowth of mesoblast, 
which enters the optic cup through the choroidal fissure. 

As the lens becomes invaginated and separated from the 
external epiblast, a layer of mesoblast extends across between 
the vesicle and the external epiblast, constituting the cornea, the 
tissues of which become transparent, The choroid and sclerotic 
coats develop from the mesoblastic tissues surrounding the optic 
cup ; the iris is formed by a forward growth of the margins of the 
optic cup ; and the anterior chamber appears somewhat later as an 
excavation between the cornea and lens. The eyelids are the last 
structures to form in connection with the eye and consist of 
folds of the skin from above and below. These extend over the 
eyeball to finally meet and become fused together, without adher- 
ing to the surface of the cornea, so that they create a closed sac, 
the lacrymal sac, between their internal surfaces and the cornea. 
In the rabbit and carnivora, the eyelids remain closed for a short 
time after birth, while, in ruminants and solipeds, the eyelids 
open somewhat prior to birth. 

The membrana nictatans, or third eyelid, is formed from a fold 
of skin in a similar manner to the two ordinary eyelids and ex- 
ists in all domestic mammals. 

The lacrymal duct is formed in the groove existing between 
the external nasal process and the maxillary arch. 

In the domestic animals, we occasionally meet with aberrations 
in the development of the eye. Sometimes the eyelids have be- 



300 Veterinary Obstetrics 

come so intimately fused that they fail to open at the proper 
time, a condition which is not usually subject to remedy. In 
other cases, the cornea fails to undergo the normal transforma- 
tion into a transparent body, but remains opaque. In yet other 
instances, there is seen growing from the neighborhood of the 
lacrymal duct long hairs, which irritate the eye but which are, 
at times, subject to surgical removal. In still other instances, 
■there is a contraction of the inner, or mucous, layer of the eye- 
lid or a comparative overgrowth of the external skin, bj' which 
means the eyelids are inverted, producing entropium. 

The Ear. 

The first traces of the ears consist of open pits opposite to the 
hind-brain at an early' period in the life of the mammalian em- 
bryo, usually at about ten to fifteen days. These pits sink in 
deeply until they come in close contact with the hind-brain and 
early acquire a communication with the auditory nerves. The 
mouths of the pits soon close and the invaginated portion be- 
comes separated from the external epiblast, to constitute the 
auditory vesicles, in which the essential parts of the ear, the 
semicircular canals, vestibule, cochlea, etc., are developed. 

The Eustachian tube is formed from the hyomandibular pouch, 
which extends out from the pharj'nx as a diverticulum. At one 
time it pushes out against the epiblast and is separated from the 
exterior by a very thin membrane consisting of epiblast exter- 
nally, in immediate contact with the inner layer of hypoblast, 
with no mesoblast between. Ivater, a layer of mesoblast grows 
in between the epiblast and hypoblast and the three constitute 
the tympanic membrane. This pouch does not normally reach 
the surface at any time during fetal life, but occasionally opens 
abnormally in various mammalian animals, to constitute gill-slit 
fistula, which rarely persists at the time of birth in a manner an- 
alogous to the open gills of fishes and other similar animals. In 
the solid ungulates, there is a large infundibulum formed in con- 
nection with the Eustachian tube, which is known as the guttural 
pouch, or air sac. The slit-like communication of this guttural 
pouch with the pharynx is sometimes abnormal in the new-born 
foal, which causes air to become impacted in it (tympany of the 
guttural pouch), which may so press upon the larynx as to 
strangle the young animal. 



The Ear 301 

The formation of the external ear, or pinna, has not been so 
well studied in domestic animals as in man. The conchal carti- 
lage arises from the mandibular and hyoid arches, which bound 
on either side the hyomandibular cleft. As shown in Fig. 36 in 
the human ear, the concha consists of a series of tubercles with 
deep fissures extending between them. We have no data to 
show that the early stages of development of the concha in our 
domestic animals are precisely parallel, but they are presumably 




Fig. 36. The left ear of a human embrj'O, lettered by Professor 
His, Br. 2, and estimated as thirty-five days old. From Mar- 
shall, after His. X 20. 

I, tuberculum tragicum. 2, tuberculum anterius helicis. 3, 
tuberculum intermedium helicis. 3 and 3c, Cauda helicis. 4, tuber- 
culum anthelicis. 5, tuberculum anti'.ragicum. 5, tubercu- 
lum lobulare. 

essentially so. By observing Fig. 36, it will be seen that be- 
tween I and 2 there is a deep fissure which, in the ear of the 
horse, is apparently marked by an important ridge inside the 
concha. It is interesting, in connection with this fissure, to ob- 
serve that foals are frequently born with a deep invagination of 
the epiblast at this point, causing a long, narrow fistula which 
extends downwards from about the middle of the internal border 
of the concha to near its base, and from which there exudes a 
viscid mucus. In other cases, this invagination extends more 
deeply and penetrates the .squamous temporal bone and, in the 
development of the osseoits tissues, the invagination is inter- 
rupted and a closed sac formed at the distal end, in which, 
ordinarily, one or more teeth are formed (ear teeth) which 
resemble more or less closely the molars of the horse and may 
grow to almost any size, projecting far above the external sur- 
face or growing inward, causing an inward bulging of the skull 
into the cranial cavity. (See Figs. 37A and B.) Various authors 



302 



Veterinary Obstetrics 



ascribe these formations to outgrowths from the buccal mucous 
membrane. A glance at the figure, prepared from a clinical 
case, indicates otherwise, and that it arises from the epiblast of 
the conchal region in a manner parallel to the formation of the 
teeth within the mouth from the stomatodeal epiblast. 




Fig. 37 A. 



The Ear 



303 







1, > 




Fig. 37 B. 
Fig. 37. Dermoid Cvst or "Ear Tooth" in Foai,. 
Indicating the method of the formation, from invagination of the epiderm. 
O, Orifice of invaginated area. FW, Fibrous wall of invaginated canal. 
EC, Epiblastic cavity. D, Tooth. ST, Squamous temporal bone. 
ST', ST", Incarcerating outgrowths of squamous bone tending to isolate 
EC from D. GD, Persistent fibrous cord connecting EC with the cap- 
sule of D ; the epiblastic canal in this cord has been obliterated. PB, 
Petrous temporal or ear bone, which constitutes a separate bone in 
the horse. AM, Anditory meatus. MA, Maxillo-mandibular articula- 
tion. 



304 Veterinary Obstetrics 

FORMATION OF THE DIGESTIVE APPARATUS. 

The alimentary canal of the embryo at first consists of that 
portion of the blastoderm which is included within the embryo 
in the process of infolding and finally becomes constricted off 
from the yolk sac by the gradual folding inward of the embry- 
onal area at its margins. For a time the alimentary tract con- 
tinues to communicate with the extra-embryonal portion of the 
blastoderm,, or yolk sac, by means of the yolk-stalk or vitelline 
duct. In some species of animals, this tube remains open until a 
comparatively late period in embryonic life and traces of it may 
be found in some of them in the umbilical cord at the time of 
birth, but it does not normally retain its relation with the 
intestines. 

The intestinal tract, during the earlj' life of the embryo, is 
divided into three sections, known respectively as the fore-, mid-, 
and hind-gut ; the first comprising that portion anterior to the 
communication with the yolk-sac, the second, the middle portion 
of the area occupied by the yolk-stalk and the third portion, or 
hind-gut, that which projects from the yolk-stalk posteriorly. 
In the fore-gut there early appear two dilations, the pharynx 
and the stomach. The gut is at first closed both anteriorly and 
posteriorly and the communications with the exterior become 
established later. The anterior end opens first. 

There appears, in that region of the embryo which is later to 
constitute the mouth, a depression known as the stomatodeal pit, 
by which the epiblast sinks inward in the direction of the pharynx 
until finally the two cavities are separated merely by a thin layer 
of epiblast and one of hypoblast, the intervening mesoblastic tis- 
sues having been absorbed. Eventually, the thin membrane 
gives way and the mouth communicates with the anterior end of 
the fore-gut, or pharynx. 

The pharynx shows a marked dilation in comparison with the 
other parts of the digestive tube. In sagittal section, the inter- 
nal surface shows the prominent visceral arches, between which 
extend the visceral pouches. Among these visceral pouches, the 
hyomandibular and first branchial are the most prominent and 
have, on the outer surface, corresponding visceral grooves, which 
do not normally open upon the exterior, but the hyomandibular 
groove becomes very thin and ultimately forms the tympanum. 



Formation of the Digestive Apparatus 



305 




3o6 Veterinary Obstetrics 

or eardrum. Rarely the hyomandibular gill-slit opens com- 
pletely upon the exterior to constitute gill-slit fistula of the new 
born. 

The embryonic line of demarcation between the stomatodeum 
and fore-gut is not perfectly known in the adult, but is in the 
immediate vicinity of the soft palate, the buccal mucosa and the 
teeth being derived from the stomatodeal epiblast, the tongue 
growing forward from the hypoblast of the floor of the fore-gut. 

L,ater in the life of the embryo, varying according to species, 
there appears, opposite the posterior end of the hind-gut, a dis- 
tinct depression in the epiblast, the proctodeal pit. The invagi- 
nation of this pit is of a similar character to that of the stomato- 
deum and soon extends sufficiently toward the hind-gut that 
only a thin membrane remains between them, consisting exter- 
nally of a layer of epiblast and internally of hypoblast. Nor- 
mallj', this pit soon opens into the hind-gut and the alimentary 
canal now communicates with the exterior, both anteriorly and 
posteriorl}^ 

Various aberrations in the development of these parts occur. 
The most common is an arrest in the development of the hind- 
gut, by which a portion of it is wanting and it consequentl}' does 
not become connected with the proctodeal pit and does not open 
exteriorly. In such cases, the young animal is born devoid of 
a rectum. In other cases, the membrane between the proctodeal 
pit and the hind-gut fails to disappear and the young animal is 
born without an anus, as shown in Fig, 42. In still other in- 
stances, as recorded b}' Gurlt, the intestine ceases at the vitelline 
stalk, passing out through the umbilicus, where it ends blindly. 

A highly interesting aberration involving the digestive tract, 
and spinal column, is that recorded bj' Gurlt and illustrated 
in Fig. 38, which he designates as Schistocormus fissi-dorsualis 
subecostatus and describes as a cleft in the dorsal wall of the body, 
beneath the spinal column on the left side, through which the 
stomachs and other abdominal viscera prolapse. 

Gurlt remarks that the aberration is very rare, he having 
known of three instances, one in the calf, two in lambs — all in 
ruminants. 

We have observed a single case, resembling that of Gurlt in 
manj' respects but showing important differences. Figs. 39 and 
40 delineate briefly its character. In this instance, the omasum, 



Formation of the Digestive Apparatus 307 

M, and the spleen, S, are protruding from a crater-like open- 
ing in the head, through the occiput. The rumen and reticu- 
lum are wanting in the specimen, fragmentary shreds indicating 
that they had been torn away accidentally or eaten away by 
some animal before the specimen came into our hands. In this 
case, the prolapse of the alimentary tract is not lateral, but dor- 
sal, immediately upon the median line, obliterating for a distance 
the cerebro-spinal axis. 




Fig. 39. ScHisTocoRMUs Fissidorsuai,is. 
Showing crater-like opening in the occipital region. 

Since the notochord becomes established prior to the formation 
of the gut, it would seem improbable that the prolapse would 
occur through that organ, but rather that it would pass in front 
of it, and this is apparently what has occurred. A study of Fig. 
41, /TV and PT, shows that, just anterior to the end of the noto- 
chord, there is an infundibulum growing down from the thala- 
mencephalon, or midbrain, while, just opposite, growing upward 
from the posterior border of the stomatodeum, is the pituitary 
pouch, which later becomes the pituitary body, the two infundi- 
buli coming into immediate contact with each other. The 
fore gut has pushed forward and upward, to escape through 
this area of low resistance, upon the back of the head. The 
fore-gut escaping, no neck has developed, and the sternum, ST, 
extends forward beneath the pharynx, P, and the basi- 
occipital bone, BS. The illustration from Gurlt likewise indi- 
cates a virtual absence of neck, though less pronounced. 

At first the alimentary canal is of the same length as the body 
and forms immediately beneath the notochord, but later it in- 



3o8 



Veterinary Obstetrics 




Skills if 



gi a S OS'S a ^g 



. "f <"^ n aj ° o 



11 

ia rt 
oj . ^ 

o a y 
o M H 



c=5 .'ao 

o o a 5-° 

3'S£ " 2 
o a o a 

gWPnOaj 

WWPhOm 




Fig. 41. A median longitudinal, or sagittal section through a rabbit em- 
bryo, at the end of the twelfth day. The section is a strictly median one 
except in two respects , the cerebral hemisphere of the left side has been 
introduced in order to render the figure more complete ; and the Wolffian 
body and ureter of the right side. The terminal portion of the tail has 
been removed. 

BF, Cavity of fore-brain or tbalamencephalon. 

BH, Cavity of hind brain, or fourth ventricle. BL, Cerebellum. 

BM, Cavity of mid-brain. BS, Cavity of cerebral hemisphere, or 
lateral ventricle. CH, Notochord, GP, Post-anal gut. 

IN, Finger-like process of infundibuluni. KC, Wolffian duct. 

KD, Ureter. KM, Wolffian body. LE, Epiglottis. 

LG, Lung. LR, Trachea. PN, Pineal body. PT, Pituitary body. 

RS, Sinus venosus. RT, Truncus arteriosus, 

RV, Ventricle of heart. T, Glottis. TA, Stalk of allantois, cut short. 

TC, Cloaca. TA, Thyroid body. TO, CEsophagus. TP, Pharynx. 

W, Liver. WD, Bile duct. YK, Yolk stalk, cut short. 

(Marshall). 



3IO 



Veterinary Obstetrics 



creases in length far more rapidly than the body and drops away 
from the dorsal portion of the body cavity to float freely, con- 
fined in position only by the mesentery, which it has derived 
from the superior wall of the abdomen and carried with it in its 
descent. 

At first the posterior gut of the embrj^o represents jointly the 
intestine and the genito-urinary passages and constitutes a sin- 
gle dilated chamber, or cloaca, but later there grows back, from 
the angle between the stalk of the allantois and the gut, a parti- 
tion which serves to separate the digestive tube from the genito- 
urinary tract. This partition is sometimes incomplete, especially 
in the female when the proctodeal opening fails in the upper 
portion and causes a closed anus, when the feces from the 
intestine drop into the vagina, to be expelled through the vulva, 
as indicated in Fig. 42. 




Fig. 42. Atresia Ani. Lamb. 

R, Rectum. P, Closed proctodeal pit. C, Cloaca. 
Ur, Urethra. U, Uterus. B, Bladder. V, Vagina. 

The Lungs. 

The lungs are formed as an outgrowth from the floor of the 
pharynx in the region of the first to third branchial arches and 
begin as a longitudinal groove, which soon develops into a blind 
pouch. This evaginatiou extends backward beneath the pharynx: 
and at its distal end soon splits into right and left halves, to con- 
"stitute the two lobes of the lungs. The growth continues back- 



The Teeth 



3" 



ward beneath the oesophagus and above the heart and the distal 
ends of the two lobes become enlarged and commence dividing 
into small lobes. The lobes elongate greatly and give rise to 
buds which end in somewhat enlarged ampuUje, which continue 
to subdivide in this manner, the terminal infundibuli constitut- 
ing the air cells, while the tubes leading from them are the 
bronchioles, the larger ones are the bronchii, the original tube 
leading from the floor of the pharynx becomes the trachea, and 
the slit which first appeared in the bottom of the pharynx forms 
the glottis. 

The Teeth. 

The teeth appear very early in the life of the embr3'o and orig- 
inate from the epiblast of the stomatodeum in the form of a lon- 
gitudinal invagination of thickened epithelium along the border 
of the jaw, which eventually sinks down into the'substance of 
the jaw as a continuous ridge, known as the common enamel 
germ. Later, the ridges become enlarged at intervals, to consti- 
tute the individual enamel organs, while the portions between 




Fig. 43. Three successive stages in the development of a tooth- 
germ of a pig embr3'0 (after Frey and Thiersch); a, b, c, layers 
of thickened oral epithelium, showing dental groove on sur- 
face in 3 ; e, enamel organ ; f , dental papilla ; g, h, internal and 
external layers of follicle wall ; i, blood-vessel ; k, maxilla ; d, 
epithelial ingrowth, the end of which expands into the enamel 
sac. (Heisler). 



312 Veterinary Obstetrics 

these enlargements tend to atrophy and finally to completely dis- 
appear. 

Each enamel organ soon consists of a flask-like vesicle of epi- 
blast with a narrow neck, which is still continuous with the epi- 
thelium of the mouth by a cord-like constriction, while the 
distal end, or fundus, of the flask is enlarged and spherical. 
Beneath this enamel organ, there soon forms, from the meso- 
blastic connective tissue, the dental papilla, which pushes up 
into the sac, causing an invagination of its base. The enamel 
sac now invests the top of the papilla as a cap and soon takes 
on the form of the future tooth. The enamel organ is then in 
the form of a flattened sac, the distal end invaginated, so that 
the two walls are brought into close proximit}^ See Fig. 43. 

Upon the external surface of the dental papillae, odontoblasts 
arise, from which the dentine of the tooth is formed. The 
enamel prisms are formed from the epithelium of that part of 
the walls of the enamel sac which lie in immediate contact with the 
dental papilla, while the superficial wall, i. e. that portion con- 
tinuous with the neck-like mass of epithelial cells still maintain- 
ing connection with the mouth cavity, disappears without tak- 
ing any recognized part in the formation of the enamel tissue. 
The dentine, forming from the odontoblasts upon the apex and 
sides of the papilla, soon invests these portions in the hard ivory 
substance, while the base and center of the dental papilla con- 
tinue as the tooth pulp. The base is at first wide open, but, as 
the tooth develops, it gradually contracts and finally, in some 
teeth, there grow out projections or septa of dentine, to consti- 
tute the roots or fangs, which divide this cavity into two or 
more distinct openings, according to the individual tooth or 
species, and, through these apertures, the blood vessels and 
nerves pass to the pulp of the tooth. See Fig. 44. 

As the enamel organ sinks down into the jaw, there occurs a 
condensation of the surrounding niesoblastic connective ti.ssue to 
constitute a capsule, the tooth follicle, which closely invests the 
enamel organ and papilla. When the bony tissue of the jaw 
forms, the follicle serves as periosteum for the tooth and alveolus, 
while, from its inner layers, the external tooth tissue, the 
cement, is developed. The origin of the dental tissues is then : 
I, the enamel from the invaginated epiblastic cells; 2, the pa- 
pilla, vessels, nerves and dentinal tubules from the mesoblastic 



The Teeth 313 

connective tissue, and, 3, the cenientuni and dental and alveolar 
periosteum from the mesoblastic dental follicle. 




Fig. 44. Sagittal section through an inferior grinder of an equine 
embryo, 4 inches long. ect, ectoderm of mouth cavity ; mes, 
mesoderm ; eo, enamel organ ; ec, enamel cells ; d, den- 
tine ; eb, embryonic bone. 

The enamel cap is at most points detached from the dentine 
papillae. The section through the tooth follicle is so made that 
the plicae of the enamel cap have split each of the dentine 
papillae so that there are four instead of two. 

When the bony jaw^s form later, the teeth are at first in con- 
tinuous grooves, but transverse osseous partitions later extend 
between the tooth germs and finally constitute separate compart- 
ments, or alveoli, for each. The permanent teeth are developed 
as outgrowths from the enamel organs of the temporary set in 
those cases where they are preceded by such ; in the others they 
are formed the same as the temporary teeth from a backward 
growth of the common enamel germ. 

The teeth of domestic animals, and especially of the horse, are 
subject to many aberrations in development. The mesoblastic 
connective tissue follicle, under disturbances, may undergo seri- 
ous aberration during its developmental stages. There may be a 



314 



Veterinary Obstetrics 



large amount of fluid formed within the follicle, which may cause 
the destruction of the tooth germ and may become enormously 
increased, to the extent of one, two or more pints of fluid and, 
when in the upper jaw, may cause serious distress to the animal 
by projecting into the sinuses and interfering with respiration. 






Fig. 46 A. 



Fig. 45. 
Fig. 45. Sagittal section of superior molars of adult horse show- 
ing on the left, normal development, on the right, arrested de- 
velopment of the cement area. 

Fig. 46. A, Crown, and B, Longitudinal cross section of a super- 
ior grinder of adult horse showing absence of cement in central 
infundibulum and erosion of the enamel and dentinal plates. 

C, External cement. C, Central cement area. 

E, External enamel layer. E', Central enamel. E", Ex- 
ternal enamel at point of contact between adjacent molars. 
The adjacent enamel laminae project above the surround- 
ing tissues, have no cement between them and are so ar- 
ranged as to prevent the impaction of food particles be- 
tween. 

D, Dentine. Er, Erosion area. Er', Erosion canal penetrat- 
ing the tooth fang. 

P, Pulp cavit}'. S, Superior maxillary bone. 

These aberrations we know as follicular cysts. In other cases, 
the walls of the follicle form an abnormal amount of cement, 
which causes a very great accumulation of this substance, to 
constitute what we know as a cement tumor, or cementoma. 



The Teeth 315 

Sometimes there is a distension of the follicle with fluid, ac- 
companied by a growth of cement upon its inner surface, giving 
rise to what we know as compound follicular cysts. 

At other times the walls of the tooth follicle become greatly 
thickened by an abnormal growth of connective tissue, to con- 
stitute what is known as a fibrous odontome. 

Finally, in the horse, and to a less extent in other animals, 
where there are deep invaginations from the sides or upon the 
crown of the enamel organ into the dental papilla, there is 
normally formed in the grinders a sufficient amount of cement 
to completely close the spaces between the infolded layers of 
enamel. In some instances this formation of cement is in- 
complete and an opening is left through the central portion of 
this substance, from the grinding surface of the tooth down to 
the bottom of the infundibulum, in close contact with the 
enamel. Through this cleft, food particles pass and, becoming 
lodged in the deepest part, undergo bacterial decomposition, 
which causes a solution of the enamel and dentine and, finally, a 
perforation of the pulp cavity, leading to a purulent inflamma- 
tion of the tooth pulp and a destruction of the life of the organ, 
with many complications of a highly important character. See 
C Figs. 45 and 46. 

The enamel organ is subject to aberrations in its develop- 
ment b}' which a tumor is formed, which may prevent the 
eruption of the tooth and lead to what is known as a multilocular 
cyst. 



•'^-C 




Fig. 47. Cross section of molar 
of adult horse. 

C, External cement. C, Cen- 
tral cement. E, External 
enamel. E', Central enamel. 
P, Pulp cavity surrounded 
by dentine. 



The dental papilla may undergo two important forms of fetal 
aberration or arrest in development. First, there may be an ex- 
cessive development of the dentinal substance to constitute an 



3i6 



Veterinary Obstetrics 



ivory tumor, or radicular odontome. Occasionally such tumors 
in the horse reach a weight of five pounds or more. 

There is frequently an arrest in the development of dentine at 
the wearing surface of the tooth. In the grinder of the horse, 
where the enamel dips down into the body of the tooth, it serves 
to bring two lamellae of dentinal substance into close contact. 




Fig. 48. A and B. Table surface and section of inferior molar of 
adult horse, showing non-fusion of dentinal lamellse, followed 
by infection and purulent pulpitis. 

C, External cement. C, Central cetnent. E, External enamel. 
E', Central enamel. P, Pulp cavity surrounded by dentine. 

In the complex grinder of the horse, the papilla or radicle of 
the tooth, d, Fig. 44, splits up into several sharp elevations 
which push their way up into the enamel organ. The dentine 
forms from the ondontoblasts upon the exterior of these pro- 
jections, and the soft tissues, or tooth pulp, occupy the interior 
of these elevations so that at their apexes the inner, or pulp, 
surfaces of the dentinal plates coine in immediate contact. 
Normally the opposing faces of these two plates should fuse 
at the grinding surface and hermetically seal the pulp cavity as 



The Teeth 317 

shown between Cand C in Fig. 46 B, and atZ?in Figs. 45 and 46 A, 
before the time when the tooth comes into wear, and the dentinal 
summit is worn away. In some cases, as shown in Fig. 48, this 
fusion fails to occur and results in an opening into the pulp cavity, 
with food particles passing through between the laminae 
into the pulp, causing a purulent inflammation of it, with 
destruction of the tooth and other important complications. 
Thus, in the early stages of embryonic life, aberrations in the 
formation of the tooth germs serve in a variety of ways to in- 
duce defects in these organs which lead to their early disease 
and destruction, accompanied by an endless variety of com- 
plications of more or less serious importance for the well-being of 
the animal. 

The mammalian tooth, the hardest tissue in the body, is nor- 
mally a product of epiblastic growth from the stomatodeum, 
which has become invaginated into the bones of the maxilla and 
mandible, but tooth tissues are not confined to these parts. 
We have already related on page 301 that tooth tissue, histo- 
logically and anatomically, is also formed in the squamous por- 
tion of the temporal bone of the equine embryo, but here the 
conditions closely simulate those obtaining in the oral cavity 
itself, that is, epiblastic cells are invaginated into the deeper 
layers of mesoblast. From the mesoblastic bone, the squamous 
temporal is formed, while the incarcerated epiblast, as in the 
jaws, develops into enamel tissue. 

From these considerations one might be led to state that the 
invagination of epiblast into embryonic tissues which are later to 
form bone leads to the development of teeth and that this condi- 
tion is essential to their origin. This, however, is not wholly true. 
Somewhat rarely in horses, and yet more infrequently in other 
animals, we meet with dental substances in the ovaries and testi- 
cles, and here the condition of the invagination of epiblast into 
mesoblast, with the incarceration of the former in mesoblastic tis- 
sue which is to ossify, does not occur. Possibly, here, the epiblast 
becomes invaginated through the giibernaculum testis or the cor- 
responding ligament of the ovary into the mesoblastic genital 
gland, or it may reach the genital gland through the Wolffian 
duct, which, according to some embryologists, arises by a longi- 
tudinal invagination of the epiblast, and, while the tissues of the 



3i8 Veterinary Obstetrics 

gland do not ossify, the very dense tunica albuginea affords a 
degree of compression of a somewhat analogous character. 

We may then state that, so far as we know, teeth are always 
liable to result whenever limited sacs of epiblast become invagi- 
nated into mesoblast, and become incarcerated and separated 
from the general epiblastic layer, while the surrounding meso- 
blast is converted into bone or is bound down by firm layers of 
unyielding connective or other dense tissues. 

The lyiVER. 

The liver of the embryo appears about the end of the second 
week as an outgrowth from the inferior wall of the intestine just 
beyond the dilation which marks the future stomach. The for- 
mation of the liver resembles in manj^ respects that of the lungs, 
the outgrowth becoming enlarged at its distal end, while the 
proximal portion becomes narrowed to constitute the bile duct. 
The liver is the most conspicuous of all the glands in the embryo 
and, at the time of birth, constitutes the largest and heaviest 
portion of the internal viscera. In volume and weight, it is equal 
to the entire intestinal tract, with the lungs and heart added. 

The Pancreas. 

The pancreas arises at about the same time as the liver, as an 
infundibulum from the anterior wall of the duodenum, and is 
lodged in the tissue of the mesentery between the intestine and 
dorsal wall. The gland quickly divides up into lobules, from 
which the acini and ducts are formed. 



THE CIRCULATORY SYSTEM. 

During the second week in the life of the embryo, the heart is 
recognizable as two symmetrical and distinct halves, which con- 
sist at this time of two straight tubes, lying along the head-end 
of the embryo between the yolk-sac and the neural folds and 
connected at their posterior ends with the vitelline vessels. 
These two tubes soon unite to form a single one, which becomes 
twisted upon itself and forms a prominent swelling on the ventral 
surface of the embryo in the region of the pharynx. It is 
twisted in an S-shaped loop and is free in its middle portion, 
while the ends are attached anteriorly and posteriorly to the 
ventral surface of the fore-gut. The posterior, or dorsal, portion 
of the heart represents the future auricles and is separated by a 
somewhat marked constriction from the ventral portion, which 
is to become the ventricles. The anterior end of the loop is 
somewhat enlarged to constitute the truncus arteriosus, which is 
attached to the fore-gut in the vicinity of the mandibular arches. 

The heart increases rapidly in size and, within a week from 
the first traces of its formation, the constriction between the au- 
ricular and ventricular portions has become very narrow, the 
auricles have assumed their ear-like form, and the ventricular 
portion lies transversely across the body, shaped somewhat like 
the adult stomach. 

The Sinus Venosus. 

The blood is returned to the heart by three symmetrical pairs 
of veins : the Cuvierian vein from the body of the embryo, the 
vitelline vein from the yolk-sac, and the allantoic vein from the 
placenta. These three pairs unite to constitute the sinus veno- 
sus, lying transversely across the body and opening into the 
auricular portion of the heart. The sinus venosus ultimately 
becomes a part of the auricle and disappears as a separate 
structure. 

The auricular chamber becomes imperfectly divided into the 
two auricles, at an early date, by outgrowths from the walls, 
which finally separate the two chambers. The septum between 
the two auricles does not become complete during fetal life, but 
Piloses normally at the time of birth ; abnormally, it may persist 

319 



320 Veterinary Obstetrics 

after birth, giving rise to the affection known as persistent fora- 
men ovale, or cyanosis of the newborn, by which the blood re- 
mains mixed, asin the serpent, giving a bluish color to the skin 
and mucous membranes, usually ending in the early death of the 
young animal. 

The constriction between the auricular and ventricular por- 
tions gradually develops to form the septum between these cavi- 
ties and, from these also, the auriculo-ventricular valves are 
formed. 

The ventricular cavity becomes divided into two somewhat 
unequal halves toward the close of the first month. There also 
forms in the trzmcus arteriosus, ta. Fig. 49, a median partition, 
which, growing backwards, divides the vessel into two parts, 
which are to represent in the future the common aorta and the 
pulmonary artery. The septum between the two ventricles is 
for a time incomplete and both the aorta and pulmonary artery 
are connected with the right ventricle only, so that the left 
cavity communicates with the arteries only through the opening 
in the ventricular septum. 

The Arteries. 

A series of aortic arches, see between va and da, Fig. 49, 
arise early in the third week of embryonic life from the anterior 
extremity of the truncus arteriosus, one for each of the visceral 
arches, the more anterior appearing first. At first there are two 
wholly separate aortse, which run parallel to each other through- 
out the length of the body just beneath the notochord, but they 
soon become fused posteriorly to constitute the dorsal aorta, 
from which is given off the vitelline arteries to the vitelline sac. 
Further back it divides into the two allantoic arteries, which 
carry the blood to the allantois. The aortic arches pass from the 
floor of the pharynx up through the visceral arches on either 
side and open into the aorta. They are soon complete, five, or, 
according to some authors, six pairs, being present, one for each 
branchial arch, and all connected above with the dorsal aorta. 

The attachment of the truncus arteriosus begins to shift back- 
ward along the floor of the mouth and divides into two branches,, 
the anterior of which maintains connection with the mandibular 
and hyoidean aortic arches, while the posterior is connected with 
the three, or four, remaining vessels. 



77^1? Arteries 




Fig. 49. Reconstruction of human embrjo of about 17 da3S 
(His): ov, optic vesicle, ot, otic vesicle; nc, nc', notochord ; 
hdg, head gut ; vs, vitelline sac ; 1, liver; v, ta, primitive ven- 
tricle and truncus arteriosus ; va and da, ventral and dorsal 
aortae ; aa, aortic arches ; jv, primitive juglar vein ; cv, cardinal 
vein ; dC, duct of Cuvier ; uv,ua, umbilical vein and artery ; al, 
allantois ; uc, umbilical cord. (Heisler). 



322 



Veterinary Obstetrics 



The aortse continue forward beyond the aortic arches and run 
alongside the brain, to constitute the internal carotid arteries. 

Changes now begin to appear, looking toward the foundation 
of the adult plan of circulation. The middle portions of the 
aortic arches in the mandibular and hyoidean arches disappear ; 
the connection between the truncus arteriosus and the aortse, 
through these arches, ceases to exist and the proximal ends of 
these vessels remain as the external carotid arteries. 

The third aortic arch remains and retains its connection with 
the anterior portion of the aorta and its proximal end or stem 
constitutes the common carotid artery. The connection between 
the portion of the aorta posterior to the junction with the third 
aortic arch and anterior to the fourth disappears, thus separating 
the carotid system from the aortic vessels. 



Common carotid 
Recurretit laryngeal 
nerve {right) 
Right subclavian 



inate artery 
nding aorta 



Internal carotid 




Fig. 50. Diagram illustrating the fate of the aortic arches. 
(Modified from Heisler. ) 

The left fourth aortic arch persists, to eventually become the 
aorta, while the fifth, or, according to those authors who re- 
cognize six aortic arches, the sixth, arch ultimately becomes the 
pulmonary arterj'. See Figs. 49 and 50. 



The Artei'ies 



323 



At approximately the fifth or sixth week of embryonic life, 
the heart leaves the region of the pharynx and passes backward, 
while the neck becomes elongated and the head extended for- 
ward, which causes a great lengthening of the common carotid 
artery. 







'OCL 



Fig. 51. Arrested Development of the Uterus and Vagina. Cow. 

O, Ovary. CL, Corpus luteum. UC, Uterine cornua. 
U, Cordiform Mullerian ducts representing the uterus. 
Va, Vagina. H, Hymen. V, Vulva. MU, Meatus urinarius. 



During the formation of the cranial nerves, the inferior laryn- 
geal divisions of the pneumogastric nerves cross behind the 
fourth, or permanent, aortic arches between the aorta and 
truncus arteriosus, to reach their destination in the muscles of 
the larynx. As the heart recedes toward the chest and the 
head grows forward, the laryngeal nerves are necessarily caught 
and dragged along with the aortse into the chest cavity, thus 
bringing about their recurrent course. 

While the heart is moving backward, the right aortic, or sys- 
temic, arch becomes smaller and finally disappears. As a result, 
the right larj-ngeal nerve is released from the dragging of the 
aorta but still passes around the right subclavian artery, while the 
persistence of the left arch, with its increased size, to become the 
common aorta continues the dragging upon the left recurrent 
nerve, which, throughout the life of the animal, must pass into 
the chest, around the aorta, and retrace its way back to the 
larynx. This essential difference in the course of the two in- 
ferior laryngeal nerves is by some presumed to have a funda- 
mental relation to the fact that, in the affectisn of "roaring" 
in horses, it is regularly the left nerve which becomes degenerated. 



324 



Veterinary Obstetrics 



^,-ffr:-^^-. 




Fig. 52. Fissicoi^us. Cervicai, Ectopia Cordis. 
(Gurlt.) 




Fig. 53. Cervical Ectopia Cordis in an Adult Steer- A, Ectopic heart. 
(Kansas City Veterinary College.) / 



The Arteries 



325 



though the essential relation of this to the disease is unknown, 
nor is there any explanation why the recurrent character of the 
nerve should cause disease in the horse and not in other animals. 




Fig. 54. Ectopia Cordis ; Schistocormus Fissisternai.is. 
After Hering. 

It should be noted here also that the heart sometimes becomes 
arrested in its movement backward and remains in the cervical 
■or pharyngeal region. It thus occurs, especially in bovidse, 
that the young may be born with the heart just beneath the 
pharynx or at any point between this and the first rib, as shown 
in Figs. 52 and 53, thus graphically reminding one of the normal 
shifting of the location of the heart from its first position along 
the floor of the pharynx, in the embryo, toward the posterior 
portion of the body, to become lodged within the chest cavity. 

In other cases, the aberration in the location of the heart 
may occur in connection with a fissure of the sternum, through 
■which the heart becomes herniated, as in Fig. 54. 

The fifth aortic arch gives oiT a branch, before joining the 
aorta, to go to the lungs and constitute the pulmonary artery. 
In the right vessel, the arch disappears between the pulmonary 
artery and the aorta, while, in the left, it continues up to the 
close of fetal life, as the ductus arteriosus, which, up to the time 
of birth, maintains the indirect communication between the right 
ventricle and the posterior aorta, and persists throughout life as 
a fibrous cord, the liganientum arteriosum. 



326 Veterinary Obstetrics 

The Veins. 

When the mammalian embryo is about three weeks old, there are 
three pairs of veins : the Cuvierian, the vitelline and the allantoic. 
The first of these return the blood from the embryo itself and 
are formed by the union of the cardinal veins. The vitelline 
veins are formed in the walls of the yolk-sac and carry blood 
from it along the vitelline stalk to the heart, while the third 
pair return blood from the placenta along the stalk of the allantois. 

The vitelline veins of mammals are naturally small, since the 
vitellus, or yolk, contains essentially no nutriment and, hence, 
affords small opportunity for any important functions in these 
veins, so long as they merely carry blood from the yolk-sac to 
the heart. Thej' are situated in the mesoblast of the splanchno- 
pleure, enter the embryo at the umbilicus and, passing forward 
along the sides of the alimentary canal, empty into the sinus 
venosus. 

In growing out from the intestine, the liver surrounds the vitel- 
line veins before they empty into the sinus venosus. Here the veins 
break up into a series of capillaries, converging later to form the 
efferent hepatic vessels. In this way, the capillary system of the 
liver is formed and we have a vein dividing up into capillaries in 
the same way as arteries usually do, and converging again to form 
a second venous trunk. At about the same period that the vitelline 
veins are breaking up to constitute the functional circulation of 
the liver, they become connected with each other just before 
their entrance into that gland, by three communicating branches, 
two of which pass beneath the duodenum and one over it, 
and thus form venous rings surrounding the intestine. From 
the anterior ring, there arise veins which carr}^ the blood into 
the liver. The right and left vitelline veins soon unite to form 
a single trunk, which, a little later, is joined by veins returning 
blood from the intestine, after which it is known as the hepatic 
portal vein. 

The veins which previously established the communication 
between the right and left vitelline veins disappear in part in 
such a way that the remaining portions, which constitute later 
the direct trunk, are twisted about the duodenum in a manner 
similar to that seen in adult life. 



The Veins 327 

The allantoic veins are at first paired, but they undergo a 
variable extent of fusion in the different species of animals ; in 
our domestic animals they are usually united into a single vein 
within the body of the fetus at an early date, while externally, 
in the umbilical cord, they usually remain separate. These 
veins, arising from the placenta, pass along the sides of the 
allantoic stalk, or urachus, and eventually reach the sinus 
venosus and empty into that cavity. Later, they lose their 
connection with the sinus venosus, the right vein becomes 
smaller and finally disappears, while the left increases much in 
volume and gives off some vessels as it nears the liver, which 
enter it directl}^, while the main portion of the vessel joins the 
hepatic portal vein prior to its entrance into that gland. 

At a slightly later date, when both vitelline and allantoic 
vessels have ceased to empty into the sinus venosus, all the blood 
from these two vessels must pass through the capillaries of the 
liver before it can reach the heart. At this period, a communi- 
cation, the ductus venosus, is established between the right 
hepatic and portal veins, by which the blood may pass from the 
vitelline and allantoic vessels across to the hepatic vein, without 
pa.ssing through the capillaries of the liver. This ductus venosus 
grows rapidly and affords a commodious and direct path, through 
which the blood may pass at once from the placenta to the heart, 
without going through the liver. It becomes obliterated in the 
foal some time prior to birth so that, in this animal, all blood 
from the allantois must pass through the liver. 

The posterior vena cava does not acquire much size until the 
hind limbs begin to form and the iliac veins unite to constitute 
its principal branches. It enters into the ductits venosus near its 
termination in the hepatic vein. 

The anterior and posterior cardinal veins unite to form the 
Cuvierian veins. The anterior cardinal vein persists in some of 
our adult domestic animals, such as the cow, as the external 
jugular vein. The posterior cardinal vein disappears in its 
middle and the posterior end becomes the internal iliac vein, while 
the anterior portion of the right posterior cardinal vein persists 
as the vena azj^gos. 

The anterior vena cava represents the right anterior Cuvierian 
vein, while the left vein disappears completely, with the possible 
exception of the coronary sinus of the heart. 



328 Veterinary Obstetrics 

The Fetal Circulation. 

In the earlier stages of the fetal circulation, all the blood re- 
turned to the heart, whether from the embryo, the placenta or 
the vitelline sac, is emptied into the sinus venosus, from which 
it passes into the cavity of the common auricle. In this way a 
complete mixture of the blood from all sources necessarily 
occurs. This mixed blood is then forced out by the auricle, 
through the truncus arteriosus, toward the head of the fetus. 

The sinus venosus later becomes a part of the auricle and into 
it empt}' the Cuvierian veins and the posterior vena cava. The 
septum between the two auricles is gradually formed, but there 
remains the foramen ovale, through which the blood can pass 
with more or less freedom. The posterior vena cava opens very 
near to the foramen ovale and a small valve at this point tends 
to cause the blood to flow from the posterior vena cava to the 
left auricle, by way of the foramen. In this way, considerable 
admixture of blood from the three different vessels still ensues. 
Later, as the left Cuvierian vein disappears, the blood from the 
head and anterior limbs is all returned through the right vein, 
or anterior vena cava, so that there are now only two vessels, 
both of which empty into the right auricle. At this period, the 
blood which enters the auricle from the anterior vena cava, com- 
ing from the head and both fore-limbs, is entirely venous in 
character, while that from the posterior vena cava is chiefly 
arterial, or red, blood coming from the placenta, with a small 
portion of venous blood added from the posterior limbs and 
other parts of the bod5^ 

By an elaboration of the valve in the foramen ovale and a 
valvular fold at the opening of the posterior vena cava, the 
blood from this vein is finally all carried directly across the 
right auricle into the left auricular chamber. 

The right auricle now receives blood from the anterior and 
posterior vena cavse and a small amount from the coronary 
sinus. The blood comes respectively from the head and fore- 
limbs, from the hinder part of the body, the placenta, the intes- 
tine and the liver and from the walls of the heart itself. The 
blood entering the heart through the posterior vena cava de- 
serves special consideration. The right allantoic vein disappears 
early in fetal life, while the left persists and enters the body 



The Fetal Circulation 329 

through the umbilicus, to pass forward to the posterior border 
of the hver, where it unites with the hepatic portal vein, so that 
the combined vessel now carries blood from the intestine, from 
the vitelline veins of the earlier period and from the placenta. 

For a period of time, generally extending to the date of birth, 
the blood may pass either through the capillary system of the 
liver or, entering the ductus veuosus, may pass directlj' to the 
posterior vena cava without going through that gland. 

The blood which is carried to the heart bj' the posterior vena 
cava is largely arterial in character, that is, it has given up its 
carbon dioxide and other waste material in the placenta and has 
derived, from the blood of the mother, oxygen and nutritive 
materials, which these veins carry to the heart. Into this 
posterior vena cava, there also enters the blood which has been 
to some degree favorably modified by passing through the kidneys 
and the liver, in which glands certain deleterious substances 
have been removed. The blood from the posterior vena cava 
consequently presents a marked contrast to that from the anterior 
vessel, which returns onlj"- the blood sent through the arteries to 
the head, neck and anterior limbs after it has performed its 
nutritive office to those parts and, consequently, comes back 
charged with waste materials, without having received in its 
course an^^ additional nutrient matter or having undergone any 
purification in passing through the tissues or organs. The 
blood brought by the anterior vena cava passes into the right 
auricle and thence into the right ventricle, from which it is 
driven along the pulmonary artery. Since the lungs are not yet 
functioning, onl}' a small portion of it enters these organs and 
virtually all of it passes through the ductus arteriosus to the 
dorsal, or posterior, aorta. Connecting with the latter at an 
acute angle, the blood is directed backward toward the posterior 
part of the body, whence it largelj' passes to the placenta, through 
the umbilical arteries, where it is relieved of its waste matters 
and, in exchange, receives oxygen and nutrient material. On 
the return of this arterial blood from the placental capillaries, 
along the umbilic veins, with its small admixture of venous 
blood along with that which has been somewhat modified by 
passing through the kidneys and liver, it re-enters the right 
auricle, to at once pass over into the left auricle and thence into 



330 Veterinary Obstetrics 

the left ventricle. From this latter cavity, it is driven along the 
common aorta until it reaches the carotid and subclavian arteries, 
through which it is carried almost wholly to the head and an- 
terior limbs. 

While the aorta is freely open from the heart along the poster- 
ior aorta toward the posterior portions of the bodj^ it seems that 
very little of the blood from the left ventricle passes backward. 
This is largel}' because the blood from the right ventricle, 
which, at this period, is as strong as the left, has already filled 
that portion of the posterior aorta posterior to the juncture of 
the ductus arteriosus with that vessel. Consequently, the blood 
pressure in the two portions of the vessel is approximately equal, 
so that there is as great a tendenc5' for the blood from the right 
ventricle to pass forward from the ductus arteriosus as for that 
from the left to pass backward from the opening of the ductus 
arteriosus when propelled through the common aorta. 

In some cases, it has been found that the aorta has become 
obliterated during embrj-onic life at a point just anterior to its 
juncture with the ductus arteriosus and posterior to the fourth 
aortic arch, so that all the blood to the posterior end of the fetus 
must pass through this vessel. This condition of independent 
anterior and posterior circulations has not interfered with the 
development of the fetus, but, at the time of birth, the circulation 
is at once blocked to all the posterior portions of the body, so that 
the new-born young must promptly perish. 

The plan of the fetal circulation is in a measure the reverse of 
that after birth, the purified or red blood coming from the pla- 
centa along the posterior systemic veins to the right auricle, 
thence passing largely to the head, neck and anterior limbs 
through the right ventricle, ductus arteriosus, carotid and sub- 
clavian arteries. This would suggest that the head received 
purer blood of higher nutritive value and that, consequently, the 
head end of the fetus should develop most rapidly. In the earlier 
stages of fetal life, this apparently holds true but later, in the 
larger herbivora at least, the development of each of the two 
ends of the body becomes approximately equal. Throughout 
fetal life, the blood of the entire body is of a mixed character, 
the red blood of the umbilic veins becoming mixed with venous 
blood before reaching the heart. 



The Fetal Circulation 331 

Prior to birth, the vitelline vessels have disappeared except in 
so far as they have persisted as portions of other vessels within 
the body. As soon as birth takes place and the umbilical cord 
is ruptured or the placenta detached from the uterus, the allantoic 
circulation must abruptly cease, while the pulmonary circulation 
must be promptly established because the respiratory functions 
have been shifted from the placenta to the lungs. 

As soon as the animal begins to breathe, the lungs must at 
once commence to function and, while, prior to birth, no blood 
of any note has passed through the pulmonary arteries and capil- 
laries, they must now promptl}' become active. In order that 
the blood from the right ventricle shall pass through the pulmon- 
ary arteries to the lungs, instead of through the ductus arteri- 
osus into the aorta, it is essential that the latter becomes 
promptly obliterated. 

The rupture of the umbilical cord finally interrupts the pla- 
cental circulation and renders u.seless all tho.se vessels within the 
fetal body whose sole ofBce was dependent upon the fetal circu- 
lation. To this end, the intra-fetal portion of the umbilical 
vein, with the ductus venosus, needs to close and disappear. 
Vestiges of the umbilical vein persist, but its channel becomes 
occluded within a very few days after birth, unless interrupted 
by disease processes. The allantoic, or umbilical, arteries must 
likewise undergo a partial degeneration and complete loss of 
function. When ruptured in the natural way, they usually part 
just outside the abdomen, though some writers (Carsten- Harms) 
allege that these arteries occasionally rupture within the ab- 
dominal cavity, especially in the cow. This is not wholly clear 
and is somewhat difficult of proof. In the foal, where it is 
generally admitted that they divide outside the abdominal cavity, 
the torn ends promptly retract within the body and, dragging 
with them the connective tissue surrounding their walls, 
normally retreat from the surface in such a manner as to pre- 
clude the possibility of hemorrhage and to greatly diminish any 
danger from infection in these ves.sels. (See Fig. 56. ) A 
little later their ruptured ends retract to the vicinity of the 
anterior portion, or fundus, of the urinary bladder, from whence 
they may be traced throughout life as connective tissue cords, 
passing from this point to the internal iliac arteries to constitute 
the round ligaments of the bladder of the adult. 



THE DEVELOPMENT OF THE URINO-GENITAL 
SYSTEM. 

The urinary and genital systems are closely allied in their 
origin and are both preceded by the Wolffian bodies and ducts, 
which for a time perform the excretory office of the kidneys and 
finally take prominent parts in the origin of both the urinary 
and genital organs. 

The Wolffian Ducts and Wolffian Bodies. 

The Wolffian ducts are claimed by some embryologists to orig- 
inate, as a pair of longitudinal grooves, in the epiblast on the 
lateral surface of the body, at about the level of the notochord 
or somewhat below. The invaginations of epiblast continue to 
sink inward into the mesoblast of the somatopleure until they 
attain the inner surface of the body cavity, in contact with the 
peritoneum. Other investigators, and apparently the majority, 
hold that the Wolffian ducts are wholly of mesoblastic origin, 
though at first lying immediately against the epiblast, as solid 
rods, which later become excavated in their center to constitute 
their cavity. For a time the Wolffian ducts end blindly be- 
hind, but later they open into the cloaca. 

The Wolffian bodies are first recognizable, during the third 
week of the embryo, as longitudinal thickenings in the dorsal 
surface of the body cavity, there being one of these ridges on 
either side of the mesentery. They develop rapidly and become 
greatly elongated so that they soon reach from the posterior por- 
tion of the cervical region back to the end of the lumbar region. 

The essential tissues of the Wolffian bodies appear to develop, 
independently of the Wolffian ducts, from the mesoblast, in the 
form of rods and cells. The rods coil somewhat upon them- 
selves and become excavated to constitute tubes and, growing 
toward the Wolffian duct, empty into it at one end, while the 
other end becomes dilated, and then invaginated, to constitute 
the Malphigian bodies, or glomeruli. Into these glomeruli, 
branches of the aorta penetrate to furnish the functional blood 
suppl}'. The veins from these glands empty into the posterior 
cardinal veins. 
332 




Fig 55 A 



Fig 55 C 

AN Tumor of Mare, Incarcerating 
Rectum. 
A, View from right side with a tumor, T, almost hidden by the con- 
striction caused by the pedicle. B, View from left side, the tumor ex- 
posed by cutting away part of mesentery. C, Schematic illustration 
of method of incarceration. I, Intestine. M, Mesentery, O, Ovary. 
T, Parovarian tumor or cyst. P, Pedicle of tumor. R, Rectum. 




Fig. 55 B. 



334 Veterinary Obstetrics 

Later the Wolffian bodies commence to degenerate and atrophy 
and finally the essential tissues of the organs almost wholly 
disappear and the Wolffian bodies, with their ducts, become 
concerned in the origin of accessory portions of the reproductive 
apparatus. 

In the female, the Wolffian bodies play no important part in 
the formation of the ovaries, but they send some outgrowths 
into these glands, which persist for a time without playing any 
essential part. Some remnants of the Wolffian bodies persist, 
however, as the parovarium, or organ of Rosenmueller, and from 
these vestigial portions of the Wolffian body the large peduncu- 
lated C3'stic tumors, occasionally seen in the mare, appear to 
arise. In rare cases these pedunculated par-ovarian tumors be- 
come looped about the rectum, inducing fatal incarceration, as 
shown in Fig. 55. 

In the female, some traces of the Wolffian duct may remain at 
its anterior end. In its posterior portion we do not observe 
remains of this duct in most animals, but, in the cow, they 
usually persist as Gaertner's canals, which sometimes become 
blocked at their mouths to constitute retention cysts. These 
present themselves as elongated sacs, arising close to the meatus 
urinarius on either side and extending upward and forward along 
the walls of the vagina. When they become very greatly dis- 
tended, they serve to interfere with copulation and, if very large, 
possible' with parturition. 

The Wolffian bodies largely disappear in the male but take a 
somewhat prominent part in the formation of the testicles and 
thus in part persist throughout life. Tubules grow out from 
the Wolffian tubules in the anterior part of the Wolffian bodies 
and finally enter the substance of the testicle to constitute the 
vasa eflfereutia, which eventually become connected with the 
seminal tubes. The coni vasculosi are derived from the anterior 
Wolffian tubules and the Wolffian duct is finally converted into 
the epididymis and vas deferens. 

The Kidneys, Ureters and Bladder. 

Before the disappearance of the Wolffian body, there appears 
toward the posterior end of the Wolffian duct an outgrowth or 
diverticulum, which is later to constitute the ureter and which, 
passing backward toward the cloaca, finally acquires an inde- 
pendent opening a little way behind that of the Wolfiian duct. 



The Reprod7ictive Organs 335 

At the anterior end, this infundibulum grows forward beneath 
the Wolffian body and dilates to form a sac which is to constitute 
the pelvis of the kidney, while, from its walls, a number of 
branching tubules grow out to constitute the uninary tubules 
and, at their ends, they enlarge to constitute the glomeruli of 
the kidney. 

At the point of communication between the ureter and the 
allantois the latter tube becomes dilated to constitute the urinary 
bladder. Behind, the allantois is constricted to constitute the 
urethra, while, in front, the narrowed portion which passes out 
through the umbilicus is known as the urachus. During the 
life of the fetus, the urine chief.}' passes through the urachus, 
which opening normally closes at the time of birth. 

The Reproductive Organs. 

The development of the reproductive organs of the female has 
already been described on page 1 1 , to which the reader is re- 
ferred. They undergo many aberrations in their development, 
due to arrests, some of which have already been noted on page 
247. Fig. 51 on page 323 illustrates an interesting form of 
arrested development of the uterus and vagina, in which these 
organs are represented by enlarged, solid cords. 

The Male Reproductive Organs. 
The Testicles. 

The testes form, like the ovaries, in the genital ridges and in 
the earliest stages the mode of origin or development can not be 
differentiated in the two sexes. Later the differentiation occurs 
through the development of some parts of the undifferentiated 
genital gland and the atrophy of others. The Wolffian bodies 
and ducts play an important part in the development of the ex- 
cretory apparatus of the testicles. In the indifferent gland the 
mesoblastic cells become grouped in cords containing small 
cells, along with the larger and more numerous primitive 
sexual cells. These sexual cords are formed from the roundish 
masses of cells, separated from each other by connective tissue 
sheaths. They eventually become elongated and hollowed out to 
constitute the seminiferous tubules. 

From the Wolffian bodies, cell cords grow out and fuse with 
the semeuiferous tubules to constitute the vasa recta and rete 



336 Veterinary Obstetrics 

testes and the latter, by further growth, form the head of the 
epididymis. The upper, or anterior, end of the Wolffian duct is 
modified to constitute the body and tail of the epididymis, while 
the posterior portions form the vas deferens, seminal vesicle and 
ejaculatory duct. 

Early in fetal life, the developing testicle shifts its location 
from its primary lumbar position toward its final normal resting 
place, in most animals in the scrotum. Formed in the per- 
itoneum of the body wall in the sub-lumbar region, the gland is 
outside or behind the parietal peritoneum and, as it .shifts its po- 
sition and descends into the cavity of the abdomen toward the in- 
ternal abdominal ring, it necessarily carries with it a peritoneal 
covering and remains attached to its point of origin by a double 
peritoneal fold, mesentery or mesorchon, between which its vessels 
and nerves pass. 

In the formation of the Wolffian body, there arises, in con- 
nection with it, the inguinal ligament, which passes from the 
fundus of the scrotum through the inguinal ring up to the 
Wolffian body. When this atrophies and disappears, the cord 
persists and maintains a connection with the testicle, as the 
guhernaculum testis, or with the ovary, as the round ligarnent. 
The gubernaculum testis consists of connective tissue and un- 
striped muscle fibers, surrounded by peritoneal coverings. Since 
the testicle, the gubernaculum testis, and the vas deferens, origi- 
nating from the Wolffian duct, form outside of or behind the 
peritoneum, as the organ descends each of the three structures 
must drag with it a double peritoneal fold, so that finally there 
appear three peritoneal folds, as shown in Figs. 56 and 57 : one for 
the testicle and its artery, A ; one for the vas deferens, V, and a 
third for the gubernaculum testis, G, G', and G", all of which 
are continuous. 

As the organ continues to descend toward the inguinal ring, 
the peritoneum of the abdominal floor, which stretches across the 
ring, evaginates through it as the processus vaghialis at P. in 
Figs. 56 and 57, into which pouch the epididymis, E, descends, 
followed later by the gland, T. The testis having formed on 
the median side of the Wolffian duct, which later forms the 
epididymis, the two structures maintain this original relation 
throughout and, when the testicle comes to rest in the scrotum, 



The Reproductive Organs 



337 



the epididymis lies upon its external face, above the gland. The 
relation as to elevation between the testicle and epididjmiis be- 
comes reversed. In the abdomen, processus vaginalis and in- 
guinal canal, the epididymis is benealh the testicle and precedes 
it in the descent but, when the testicle finally reaches the bottom 
of the scrotum, it performs a partial revolution forwards on its 
long axis, which reverses the relation and brings the epididymis 




Fig. 56. Genito-iirinar}' sj'stem of a foal, 24 hrs. old, to illustrate descent 
of testicles and behavior of ruptured umbilic arteries. 

The central portion of the abdominal floor has been partlj' excised and 
laid back. Seen from below. 

T, Testicle. A, Artery of testicle. G, Gubernaculum testis. V, Vas def- 
erens. B, Bladder. UA, Ruptured ends of vimbilic arteries retracted within 
abdomen. P, Processus vaginalis UV, Umbilic arter}'. 



338 



Veteri?tary Obstetrics 



above the testicle in the horse. In ruminants, this reversal of 
relation doesnot occur, as the long diameter remains perpendicu- 
lar. The processus vaginalis remains normally open throughout 
life in the domestic animals, but in the adult it is so narrow that 
abdominal viscera may not escape through it. 

When the testicle has descended into the scrotum, it is attached 
posteriorly at the bottom to the fundus of the sac by the guber- 
naculum and upwards along the posterior wall of the scrotum and 
inguinal canal bj' the frenum, consisting of the peritoneal dupli- 
cature between V and G in Fig. 57 ; above, the gland is connected 
bj' means of the testicular or spermatic cord, consisting of the 
vas deferens, arteries, veins and lymphatics covered by peritoneum. 
In the foal, pig, and more rarely in other species, at the time of 
birth, we frequently meet with a hernia (congenital scrotal 
hernia) of intestines or omentum through an abnormally large 
processus vaginalis, alongside the .spermatic cord. 




Fig. 57. Right Inguinai, Region of Foal, 24 Hrs. Old 
Illustrating descent of testicle, viewed from below, the testicle 

lifted upwards to reveal attachments. 
P, Processus vaginalis, surrounded by a dotted line and contain- 
ing a curved sound, S. G, Gubernaculum testis emerging from 
the internal inguinal ring and reaching to the larger portion, 
G', which extends to the epididymis, E, and is succeeded by 
the final or third section of the gubernaculum, G", reaching 
from E to Ihe testicle, T. 
A, Artery of testicle. V, Vas deferens. B, Bladder. UA, Um- 
bilic arteries. 



The Reproductive Organs 339 

In some instances, the epididymis, E, Fig. 57, descends into 
the scrotal sac, while the gland remains in the abdomen or in- 
carcerated in the internal ring. Far more frequently, both gland 
and epididymis are retained within the peritoneal cavity to con- 
stitute cryptorchidy. The successful castration of cryptorchid 
animals depends fundamentally upon a practical knowledge of 
thetrackandmodeof descent of the testicle, and ofitsattachments, 
through the medium of the gubernaculum testis, vas deferens 
and testicular artery. 

The Wolffian ducts open early, at their posterior ends, into the 
terminal portion of the allantoic stalk, which is later to consti- 
tute the urethra, which, in the male, elongates backward to ex- 
tend to the distal end of the penis. The penis of the male and 
clitoris of the female arise alike as outgrowths from the ischial 
arch ; in the female it stops short in its growth as a non-essen- 
tial erectile organ, without acquiring any relationship with the 
urethra, while, in the male, it becomes greatlj' elongated and, 
curving downwards and then forwards, passes between the thighs 
to end in a special sheath and prepuce. The urethra extends 
throughout its entire length to open at the extremitj' of the glans 
penis. 

Arrests or aberrations in development of the penis occur, con- 
sisting usually of an abbreviation in its length, suggesting a 
graduation in extent between a normal penis and clitoris. 
Sometimes the defective penis is directed more or less backwards, 
leading to a backward direction of the urinary stream. In other 
instances, the formation of the urethra is aberrant and it opens 
at the ischial arch or lower down along the penis, to constitute 
hypospadius or epispadius. 

Defects in the development of the penis and clitoris are largely 
associated with aberrations in the essential genital organs them- 
selves, partaking more or less of hernaaphroditism or bi-sexual 
character. Hermaphroditism varies greatly in character and 
extent and tends largely to follow certain types for each species 
of animals. In the horse, it is not rare to meet with an animal 
having a well developed vulva, vagina and uterus, the vulva 
and vagina functioning, the latter ballooning under manual ex- 
ploration, as in a normal mare. No ovaries are present but, 
instead, typical cryptorchid testicles producing the ordinar}^ 



The Limbs 



341 



cryptorchid sexual reflex, a male voice, form and behavior. 
Such a case was readily castrated by us through the ample 
vagina in the same manner as spaying a mare. (Fig. 58). The 
elongated clitoris, which projected 2 or 3 inches beyond the 
vulva, was amputated. The udder was well developed. In 
other cases in the horse, we have observed well developed mam- 
mae with testicles resting just above and to the outer side of 
them, an abbreviated penis and no vulva. Between these types 
various gradations appear. In a boar, as shown in Fig. 14, we 
found a male gland (testicle) on one side and a female, (ovary) 
on the other. 

The lyiMBS. 

In a rabbit embryo of about the tenth day, the mesoblastic 
cells on either side of the notochord become grouped into cuboid- 
al masses, divided from each other by transverse lines, which 
are known as somites or primitive segments. The first pair ap- 
pears in the cervical region prior to the closure of the neural 
tube and additional somites appear, extending forward toward 
the head end and backward toward the tail. From these somites 

a./ mh Ai /f 




vA ud pk A Ifh ^w r/ 

Fig. 59. Rabbit embryo of the ninth day ; seen from the dorsal 

side (after Kolliker.) X^i- 
stz. Stem zone, pz. Parietal zone. In the stem zone S pairs of 

somites appear on either side of the chorda dorsalis and neural 

tube. 
ap. Area pellucida. rf. Medullary groove, vh. Fore-brain, 
ab, Eye vesicle, mh, Mid-brain, lib. Hind-brain, 
uw. Primitive segment, h. Heart, 
ph, Pericardial portion of body cavity, 
vd, Margin of entrance to foregut. af, Amniotic fold, 
vo. Vena omphalo-mesenterica. (Heisler). 



342 



Veterinary Obstetrics 



md 







Fig. 6o. Human Embryo of aboi'T 28 days, showixg limb buds. (His)_ 

I to V, Brain vesicles, f, f-, P, i*. Cephalic, cenical, dorsal and 
lumbar flexures, op, E^'e. ot, Otic vesicle, ol, Olfactory- pit. 
mx, md. Maxillary and mandibular processes of first -i-isceral 
arch, sp, Sinus precer%-icalis. li',h-. Heart. 1, li. Limbs, als. 
Allantoic stalk, ch. Villous chorion. (Heisler. ) 



The [,imbs 



343 




Fig. 6i. Peromelus Apus. iGurlt). 




Fk;. 62. Peromelus Achiri's. Foal. 



later arise the vertebral column, the skeletal muscles, tendons 
and ligaments and the corium, or deeper layer of the skin. 

The formation of the limbs begins as small buds, or outgrowths, 
arising from the mesoblastic somites soon after the third week in 
the human embr\-o, earlier in the rabbit and probably in most of 
our_domestic mammals. The limb-buds each represent several 
mesoblastic somites, as indicated by the fact that the nerves pass- 
ing to each limb are formed bv the union of branches from sev- 



344 Veteri7iary Obstetrics 

eral intervertebral nerves, each vertebra representing a somite. 
The buds lengthen to constitute the limbs, the bones arising from 
the connective tissue, while the muscles develop from, the muscle 
plates of the mesoblast. The segments of the limbs are brought 
about by transverse grooves where the joints are later to form 
and the digitations begin as longitudinal grooves, which deepen 
into clefts. 

Various aberrations in the development of the limbs occur in 
our domestic animals. Merely the buds may appearand, within 
them, rudimentary bones representing the scapula and pelvis 
or, more or less also, the humerus and femur, but the other 
parts may fail of development. Any one, or all, of the 
limbs may be wanting. Fig. 6i represents the skeleton of a 
bovine fetus without limbs (Peromelus Apus), while Fig. 62 
represents a foal, in which the two anterior limbs are wanting 
(Peromelus Achirus.) In such cases the defect is apparently 
due to an arrest in the development of the limb-buds during the 
first month of pregnancy. Between this absence of limbs and 
their normal development occurs every gradation of arrest in 
the development of limbs, as peromelus micromelus or dwarf 
limbs. Rarely a limb may undergo amputation during its earl}' 
stages of development by becoming involved in a loop of the 
umbilical cord. 

A more common aberration in the limbs and feet is abnormal 
fission, by which the entire limb or its digitations become multi- 
plied. Most commonly, only the digits are involved, resulting 
in one or more extra digits, as shown in Figs. 63 and 64. 

Sometimes a greater part of the limb is involved in the ab- 
normal fission. Rarely normal fission fails in those animals nat- 
urally provided with two or more digits or, after their more or 
less complete fission, fusion occurs between them and the animal 
is born with less toes than normal. 

Rarely, in the development of the limbs, a tendency is shown 
toward the addition of an element not normally preseut in the 
genus but regularly occurring in some other genera, as is illustrated 
in well developed clavicles in the pig, as shown in Fig. 65. 



77/1? Limbs 



345 




Fig. 63. Megai^omelus 
Peri,ssodactyi.us. Pig. 






Fig. 64. 
Megai,omelus Perissodactvia's. Foal. 




Fig. 65. Humeri of Pig, with Clavicle- like Outgrowths. 



345 



Veterinary Obstetrics 





Fig. 66. A, Foal with 
bent anterior meta- 
carpal bones, show- 
ing extreme dorsal 
flexion of metacar- 
po-phalangeal arti- 
culations. 

R, Bent metacarpi 
from A. 



Fig. 66 B. 
The limbs are furthermore subject to a variety of contractures, 
sometimes involving a misdirection of the limb due to deformity 
of the articulations, at other times to a bend in the bone itself, 
as shown in Fig. 66 A and B. 



THE FETAL MEMBRANES AND THE PLACENTA. 

The maintenance of the intra-uterine existence of the fetus, 
and its development to a degree which will enable it to maintain 
a more or less independent existence at the time of birth, requires 
that effective means be established for the exchange of nutritive 
and waste materials between the mother and her young, not 
alone for the basic purposes of nutrition and excretion, but also 
that the embryo may be moored or fixed at a given point in the 
maternal organ, where its position can be maintained throughout 
the duration of pregnancy in such a manner as to best protect 
and insure its life and normal growth. To this end there are 
formed three structures from the blastodermic vesicle, which 
undergo changes to finally constitute the fetal membranes and 
placenta. 

I. The Vitelline, or Yolk Sac. 

When the embryo commences to develop, the embryonic area 
folds inward at its borders, leading to a constriction between this 
area and that part of the blastodermic vesicle which lies beyond, 
and thej' finalh' become separated except by a narrow neck, the 
vitelline duct, while, beyond, there exists the comparatively 
large vitelline or j^olk sac. This vitelline, or yolk, sac plays but 
a minor part in the development of the embryo and tends to 
more or less completely disappear, according to species, while in 
some it persists as an embryonal vestige to the time of birth. In 
the mare, the yolk sac is very inconspicuous early in fetal life 
and disappears almost completely at a very early stage. In 
Fig. 74 this general plan is suggested at the twenty-eight day of 
pregnancy, while in Fig. 75 it is indicated that, at five months, 
it has well nigh disappeared. 

In the sheep, as shown in Fig. 76, it assumes a wholly differ- 
ent form and undergoes great elongation. In other of our 
domestic animals there are variations in the form which this sac 
assumes, but, in each alike, it is of apparently little importance 
except during the very earliest stages of embryonic life. 

2. The Amnion. 
The amnion commences to form as soon as segmentation has 
been completed and the ovum has passed through the oviduct 
and reached the uterus. This occurs at about the 13th or 14th 

347 



348 



Veterinary Obstetrics 



Primitive groove. 




Entoderm. 

Transverse section of the embryonic area of a fourteen-and-a-half-day 
ovum of sheep. ( Heisler, after Bonnet). 




dial civity. 

Fig. 68. Transverse section of a sixteen-and-a-half-day sheep-embryo. 
(Heisler, after Bonnet), 
daj' of gestation in the embryo of the sheep and is soon complete. 
The date of its appearance in other domestic animals is approxi- 
mately the same. 

The amnion arises from the extra-fetal portion of the somato- 
pleure, which folds upward around the margin of the embrj'onic 
area beneath the zona pellucida, or prochorion. It forms a double 



77/1? Aninio7i 



349 



membrane which, by continuing to grow upward and converge, 
finall5' meets above the dorsal surface of the embryo and fuses. 
Bj' the fusion there is formed a double sac which envelops the fetus 
completel}' except at its point of origin at the ventral surface, where 
it takes part in the formation of the umbilicus. The inner of these 
two membranes constitutes the true amnion, while the external one 
forms the external or false amnion which, fusing with or re- 
placing the prochorion, forms the primitive chorion and later, 
when the allantois grows out, blends with it to contribute to the 
formation of the permanent, or allantois- chorion. This outer, or 




Notockorri. Somite. Gut entoderm. 

Fig. 69. Transverse section of a sixteen-and-a-half-day sheep-embryo 
with six somites. (Heisler, after Bonnet). 

false, amnion is merely a portion of the external wall of the 
blastodermic vesicle, without its relations having been changed 
exteriorl}'. The space between the amnion and the fetus con- 
stitutes the amniotic cavity and is filled with the amniotic fluid. 
As the amniotic cavity becomes filled with fluid and enlarges, 
it closely invests the vitelline stalk and the allantoic cord in its 
passage through this cavity. The amount of liquor amnii varies 
greatly in different animals and at different periods of pregnancy, 
but it is generally most abundant at about the middle of gesta- 
tion. In the cow and mare the amount of amniotic liquid varies 
from 5-6 liters, while, in the sheep, according to St. Q.yr and 
Violet, it varies between 100 and 500 grammes. In woman, the 
amount is said to be about i Vn liters. 



350 



Veterinary Obstetrics 




Placental Tufts 



Fig. 70. Schematic longitudinal section of fetal annexes of 
mammalia. At the points indicated by + the skin is con- 
tinuous with the amnion. (Bonnet). 



The Amnion 351 

An increase of this fluid constitutes what is known as dropsy of 
the amnion, which accumulation, in the cow, may sometimes reach 
the enormous amount of 20 or more gallons and prove so burden- 
some as to prevent the patient from arising when down, because 
of the great weight of the accumulated fluid. (See Dropsy of 
the Amnion.) 

In some cases, especially in the embryo of the cow, the 
amnion apparently becomes contracted during the early stages of 
its formation and causes an. eversion of the somatopleuric portion 
of the embryo, resulting in the condition which we know as 
Jissura ventralis or schistosonius reflexiis. In this deviation, no 
body cavity is formed and the internal viscera, derived from 
the splanchnopleure, lie free within the chorion. In other words, 
the constriction and infolding of the splanchnopleure to constitute 
the intestine proceeds. The constriction which' should ex- 
ternally mark the division between the fetal and vitelline por- 
tions of the somatopleure, to constitute the umbilicus, . fails to 
develop; the amnion contracts; the spinal axis of the embryo 
bends ventralwards, in a way pas.ses out through the non-con- 
stricted umbilic area and the embryo, so to speak, turns inside- 
out. The spinal axis of the fetus becomes sharply doubled 
dorsally and the somatopleuric portions lie as a partially everted 
sac with its peritoneal surface presenting externally. This ab- 
normality constantly causes serious difflculties at the time of 
parturition and frequently taxes the resources of the obstetrist 
to overcome them. This will be more fully considered when 
dealing with dystocia. See Figs. 71 and 72. 

Other interesting defects in the development of the amnion 
occur, one of the most frequent being adhesion of this membrane 
to the epiblast of the fetus, largely upon the head, by which,- 
at the time of birth, the fusion between the skin of the fetus and 
its membranes offers an important or serious obstacle to its ex- 
pulsion. 

The liquor amnii contains albumin, sugar, urea and other ele- 
ments of urine and, in man}' cases, especially in the foal, also 
some masses of meconium. The avenue by which each of the fluid 
substances reaches the amniotic cavity has not been fuUj' shown. 
Some hold that the fluid transudes into the cavity from the 
amnion itself, coming indirectly of course from the blood of 




Fig, 72. Schistocormus reflexus, after partial embryotomy to over- 
come dyslokia. 

E, Left ear, above which is seen the radial portion of the left carpus. 

F, Right antt rior foot. R, Ribs. S, Sternum. 

PI/, Lacerated area where posterior limbs have been torn away. 



The Allantois 353 

the mother. It is obvious that the meconium observed in the 
amniotic fluid of the foal has been expelled from the intestine 
through the anus and that, the anterior end of the alimentary tract 
opening also into this cavity, any discharge of secretions or 
debris from the mouth or nostrils falls at once into the amniotic 
cavity. It is also clear that urine may be readily and freely ex- 
pelled into this cavity and that the urinary salts found in the 
amniotic fluid are derived from the fetal kidneys and discharged 
into the amniotic sac through the urethra. 

The amnion consists, on the embryonic side, of a thin layer of 
epiblast, while, on the outer side, it is formed from the somato- 
pleuric mesoblast. The external surface of the amnion is in 
contact throughout more or less of its extent, varying according 
to species, with the inner wall of the allantois. 

The Allantois. 

The allantois arises as an evagination from the hind gut just 
posterior to the vitelline duct and grows outward and backward 
between the two amniotic layers, and, in the mare and carnivora, 
finally envelops the amniotic sac completely, so that, in these 
animals, there occur two complete envelopes to the fetus, 
each of which is eventually filled with fluid. (See Figs. 74, 75. ) 

Tracing the allantois from its origin in the hind gut, there is 
a slight constriction which is to constitute the urethra, followed 
by a dilation from which the urinary bladder is to develop, then 
an elongated, narrow tube, the urachus, which extends from the 
fundus of the urinary bladder out through the umbilicus and 
along in the umbilical cord across the amniotic cavity. 

In structure, the inuer layer of the allantois is of hypoblast 
derived from the inner layer of the hind gut, while the external 
layer consists of mesoblast, in which the allantoic vessels are 
formed to constitute the vascular layer. 

In all our domestic animals, the allantois constitutes a great 
sac, which is filled with a liquid, the allantoic fluid, which con- 
sists largely of the secretions from the kidneys, augmented per- 
haps by transudation from the blood vessels of the walls of 
the sac itself. The allantoic fluid contains albumin, grape sugar 

23 



354 



Vetermary Obstetrics 




Kent in the Wall 
of the Ovum 

Fig. 73. A, Embryo of the horse in its membranes. 4.2 cm. in its 

greatest diameter. Twentj'-eight days after fecundation. 
B, The same seen from the other side. (Bonnet). 



The Chorion 355 

and urea and is, consequently, similar in character to the amniotic 
fluid, except that no meconium can reach this cavity since only 
the urinary tract communicates with it. 

In the fetus the urinary secretions may pass either backward 
through the urethra into the amniotic cavity or forward through 
the urachus into the allantoic cavity and, consequently, through 
this tract the two cavities communicate throughout intra-uterine 
existence. In the human embryo there is virtually no allantoic 
sac except for a very brief time early in pregnancy, the walls of 
the allantois soon coming in immediate contact. 

Collectively, these membranes, with the addition of the vesti- 
gial remains of the vitelline sac, constitute the fetal membranes, 
or after-birth. 

The Chorion. 

The external or vascular layer of the allantois, with the ex- 
ternal or false amnion, constitutes the permanent or allantoic 
chorion. In the brief interval elapsing between the formation of 
the amnion and the allantois, the external or false amnion per- 
forms temporarily the functions of the placenta by throwing out 
placental tufts which acquire intimate attachments with the 
mucosa of the uterus, maintain the attachment and fixation 
of the embryonic mass in its position and provide an avenue for 
nutrition and excretion. I^ater, when the vascular layer of the 
allantois spreads over the inner surface of the false amnion and 
fuses with it, the allantoic tufts push out into the existing 
amniotic structures, acquire intimate relations with the uterine 
mucosa and lead finally to the displacement or effacement of the 
amniotic chorion. 

The form, extent and relations of the allantois in different 
animals present the greatest variability. In the mare, as indicated 
in Figs. 74 and 75, the allantois grows completely around the 
amnion and constitutes a complete double envelop, except for the 
area occupied by the vestigial yolk sac. It thus completely 
separates the amnion from the false amnion or amniotic chorion, 
its sac being filled with the allantoic fluid. Its internal surface 
is lined with endoblast from the enteric canal, while its exterior 
layer is of splanchnopleuric mesoblast. A study of Fig. 75 shows 
that the somatopleuric mesoblast, or outer layer of the true 
amnion, is in contact with the splanchnopleuric mesoblast of 



356 



Veterinary Obstetrics 



the allantois : these, though separable, adhere somewhat in- 
timately, the two together constituting the sac usually designated 
as the amnion. Similarly, the external wall of the allantois 
presses against the mesoblastic layer of the amniotic chorion or 
false amnion, fuses with it and constitutes the allantois-chorion. 



jv^ Allantois 

■Allantois Chorion 




Fig. 74. Schematic illustration of fetal annexes of the embryo of 
the horse, 28 days after fecundation, as in Fig. 73. Perpendicu- 
lar section through the embryo and its envelops. 

The embryo in black. — Ectoblast Vitelline layer. 

Parietal mesoblast. — Visceral mesoblast. (Bonnet). 

In ruminants and swine, unlike the globular or spheroidal 
blastoderm of the horse as shown in Figs. 73 and 74, it becomes 
very greatly elongated, as shown in Figs. 76 and 77, longer even 
than the uterine cavity, necessitating its folding upon itself. 
This elongated sac does not persist, but soon atrophies and 
almost wholly vanishes long before birth. The formation of the 
allantois follows more or less the plan of the blastoderm and its 
yolk sac and in these animals becomes much elongated. In 
swine the apices of the allantoic sac are destitute of placental 



The Chorioh 



357 



tufts, as shown in Fig. 77. In ruminants, Fig. 80, the allantoic 
sac becomes much elongated, while its apex, along with the 
amniotic chorion, finally undergoes necrosis, as shown on the 
right of the figure, or the apex of the amniotic chorion alone be- 
comes necrotic without the allantois having penetrated it, as 
shown at the left. 

In case of single pregnancy, the allantoic sac of the ruminant 
occupies both cornua. The arrangement of the allantois in 
ruminants differs greatlj' from that of the horse. The allantoic 
sac does not completely surround the fetus but, lying along its 
ventral side, greatly elongated, only partially enclo.ses the amnion. 



Epithelial Tkickeninrs 
■>/ tke Amnion 



Outer). Allantois 




Fig. 75. Schematic longitudinal section of a horse embrj'O in its annexes, 
at about 5 mos. gestation. Reduced to about ',-^. (Bonnet). 

This applies, however, only to the inner or hypoblastic layer of 
the allantois, which constitutes the immediate wall of the sac. 
The vascular, or mesoblastic, layer extends completely around 
the fetus and its amnion but, over that portion of the amnion 
where the allantoic sac does- not extend, the amnion, vascular 
layer of the allantois and amniotic chorion are unseparated by 



358 



Veterinary Obstetrics 




The Placenta 359 

any intervening fetal fluids. Mesoblast being everywhere con- 
tiguous to mesoblast, the amnion becomes adherent to the chorion 
over a large area, to such a degree as to make their separation 
difficult. 

This difference in the character and extent of the allantois es- 
tablishes a marked difference in the phenomena of parturition. 
In the mare, where the allantois constitutes a complete envelop- 
ing sac filled with fluid, the fetus tends to be born enclosed with- 
in the amniotic sac, including the adherent inner or amniotic 
layer of the allantois, while, in ruminants, the extensive area 
of the amnion not covered by the allantoic sac causes the amnion 
to remain adherent to the chorion and the fetus to be born 
naked . 

The Placenta.' 

By the term placenta we understand those portions of the fetal 
membranes or annexes which serve to bring about an intimate 
contact between the circulatory system of the mother and that 
of the fetus. The development of the mammalian embryo can 
proceed independently for but a brief period since, having 
virtually no nutrient reserve in the vitellus, its growth must 
depend upon nutritive substances obtained from without, from 
the uterus of the mother. When the morula reaches the uterine 
cavity at the eighth to tenth day, the zona pellucida throws 
out tufts, the primordial chorion, which enter into somewhat 
intimate relations with the uterine mucosa, but this zone soon 
becomes attenuated, and disappears as the blastoderm rapidly 
enlarges within it. This primitive chorion, or prochorion, must 
be replaced by a more permanent and efficient structure for the 
nutrition of the fetus. 

Soon there grow out, from the surface of the epiblast, tufts or 
villi which extend into the mucosa of the uterus through which 
there is an exchange of nutritive material and waste products 
between the mother and fetus. When the amnion develops, the 
external or false amnion is but a continuation of the somato- 
pleuric wall of the yolk sac, which completely invests the embryo. 
Over the entire surface of this embryonic sac, villi grow out to 
establish relations between the embryo and mother and consti- 
tute the amniotic chorion or placenta. These structures, like the 
preceding, are primitive and temporary in character and soon 
become lost as unimportant parts of the more permanent structure 
to follow, or they atrophy and disappear. 



360 Veterinary Obstetrics 

When the vascular laj er of the allantois develops, it grows out 
and fuses with the amuiotic chorion, which largel}' disappears 
or becomes lost as a separate membrane, while the blood vessels 
from the allantois grow out through it to constitute new tufts, 
which soon attain an intimate relation with the blood vessels of 
the uterus. 



Allantoic 
Epillielinm 



Bloodvessels 

A 



.7;-: 



U 



uterine 

Muscular 

Layer 



Bloodz'essel 
Fig. 78. Section through the chorion and uterine mucosa of the horse, at 
<)% months. Enlarged about .45-1. (Bonnet). 

The blood vessels of the fetus and those of the mother do not 
become continuous, but are constantlj' separated by three layers 
of tissue, the endothelial laj^ers of both the maternal and fetal 
capillaries and an intervening layer of connective tissue. The 
capillaries of the allantois become greatly branched and grow out 
as villi which, sinking into the mucous membrane of the uterus, 
come into immediate contact with corresponding capillar}' loops 
from the uterine vessels and become closely adherent with each 
other with extremely thin walls, through which there is a free 



The Placenta 



\(>l 



exchange of nutritive and waste products, but not of cellular 
elements. 

The separation of the fetal from the maternal circulation is so 
complete that most micro-organisms of disease do not ordinarily 
pass through and. consequently, where the mother is affected 
with a contagious disease, the fetus does not ordinarily contract 
it through the medium of the blood. For example, in tubercu- 
losis the fetus is almost never infected during its intra-uterine 
existence, but is born free from the malady, however badly the 
mother has been affected during the period of pregnancy. 




Fig. 79. Cotyledons of a cow, according to Colin. 

u, Uterus. Ch. Chorion. C'. Maternal, C-. fetal portion of cotyledon. 
Fetal and maternal portions are partly separated from each other. 
Bonnet. ) 

The area, or areas, in the mucosa of the uterus at which elabo- 
rate changes take place for the attachment and nutrition of the 
fetus, is known as the maternal placenta and the corresponding 
portion or portions of the chorion which sends capillar}- tufts 
into the placental area of the uterus, constitute the fetal placenta. 

Among our domestic animals, there are great variations be- 
tween these placentEe. In some species, the relations existing 
between the fetal villi and the capillaries of the uterus are so 
intimate that, when the fetal placenta is removed, a portion of the 
mucous membrane of the uterus is carried with it, while, in 
other animals, the placental ^-illi of the fetus separate from the 
maternal tufts and leave them intact. From this difference in 



362 



Veterinary Obstetrics 




The Place7ita 363 

the mode of the separation or dehiscence of the fetal membranes, 
we divide mammalia into two groups, known as the deciduata, 
in which the maternal mucosa is torn away with the fetal mem- 
branes, and the indeciduata, in which the separation between the 
fetal membranes and uterus occurs between the villi of the 
chorion and the maternal vessels. 

By some authors, the term placenta is limited to those struc- 
tures in which the villi of the chorion are concentrated at cer- 
tain points upon its surface. These animals are designated as 
placental. In other animals, the villi are scattered over the en- 
tire surface of the chorion and these are designated as diffuse 
placental or aplacental. 

Among our domesticated animals, in the indeciduate group, 
we have, of the aplacental or diffuse placental type,, the horse 
(Fig. 75) swine and camel, and of the placental group we have 
the ruminants, except the camel. 

In the deciduous group are the elephant, carnivora, rodentia 
and monkeys. 

In man and the anthropoid apes there is a very complex de- 
ciduous placenta, of a discoid type, with a decidua reflexa. 

Our most common and useful animals belong to the indeciduate 
group, in which are found the ruminants and equidse, while in 
the deciduate group we have only the dog, cat and rabbit. 

The form and extent of the placenta in the different species of 
animals varies greatl}'. In equidse and swine the placentae or 
chorionic villse are diffused over the entire surface of the chorion, 
as small elongated tufts, which we know as diffuse placentas. 
In ruminants the villi are restricted to comparatively small areas 
of about 80 to 100 or more in number, which are known as 
placentules or cotyledons. Between these cotyledons the chorion 
is free from the uterus. In the non-gravid uterus of the 
ruminant, there exist numerous elevations upon the surface of the 
mucosa, which constitute the rudimentary cotyledons. When 
impregnation takes place the cotyledons become highly vascular 
and their mucous membrane undergoes marked development, 
while, from the chorion, there grow out, at points corresponding 
to these eminences, numerous branched villi which ultimately 
sink deeply into the mucosa of the cotyledons or placentules. 
This condition gives rise to what we know as multiple placenta. 
(See Fig. 79.) 



364 Veterinary Obstetrics 

In carnivora, the placentse are zonular, the chorionic villi 
are restricted to a zone encircling the embryonic sac and the an- 
terior and posterior poles of the chorion are devoid of villi. 

The Umbilical Cord. 

The umbilical cord serves chiefly as a bond of communication 
between the embryo and the placenta. It is formed by the allan- 
toic stalk, surrounded by the amnion, and includes the vestige or 
remnant of the vitelline duct. In the mare and carnivora it maj' 
be divided into the amniotic and- allantoic portions. The am- 
niotic portion, or the umbilical cord proper, extends from the 
umbilicus of the embryo, through the amniotic cavity, to open 
into the cavity of the allantois. The allantoic section of the 
umbilic cord extends across the allantoic sac, from the amnion 
to the allantois-chorion. Cross-section of the umbilical cord in 
the amniotic portion reveals the following structures : the am- 
nion, serving as a thin, dense, investing membrane ; the two 
umbilical arteries, the pair of umbilical veins, sometimes fused 
to constitute a single vessel ; the urachus and the vestiges of 
the vitelline duct. Around these vessels, filling out the amni- 
otic sheath and investing the urachus and vessels within to con- 
stitute a more or less even cord, is a gelatinous substance, the 
Whartonian gelatin, embedded in a network of delicate connec- 
tive tissue. 

The allantoic portion of the umbilic cord consists essentially of 
the mass of umbilic vessels, which have now become more or less 
branched. Partially surrounded by, and adherent to, these vessels 
may exist more or less evident remnants of the vitelline duct 
and sac, prominent in the very early stages of fetal life, rapidly 
disappearing more or less completely at a later date. The urachus 
ends in a funnel-shaped dilation just beyond the amniotic sac, to 
become continuous with the allantoic sac. 

During the earlier stages of gestation there normally projects 
into the umbilical cord one or more loops of intestine and, in 
some cases, portions of the liver or of other viscera. The pro- 
truding intestinal loop escapes through the umbilic ring of the 
somatopleure, beside the allantoic stalk, inside the skin and 
amniotic sheath. The protrusion through the umbilicus ap- 
parenth' occurs because the abdominal cavity' has not developed 



The Placenta 365 

with sufEcient rapidity to accomodate the rapidly growing 
visceral mass and, consequently, a portion of it is cro^vded out 
through the umbilical opening alongside the vessels and remains 
outside of the abdominal cavity until the contraction of the 
umbilicus gradually forces the intestine's back into the now more 
capacious abdomen where they permanently remain. In numer- 
ous cases the umbilic ring does not normally contract, the ring 
remains open, the intestinal loop fails to return within the 
abdominal cavity and the fetus is born with umbilic hernia. 

The vessels of the umbilic cord are disposed spirally from left 
to right, a condition sometimes suspected to be due to a re- 
volution of the fetus upon its short axis but apparently more 
properly referable to a fundamental plan in development unin- 
fluenced by fetal movements. The spiral arrangement of the 
cord adds to its compactness and strength and to the maintenance 
of the vessels in regular order. 

The length of the umbilic cord varies widel}' with species and 
individuals. In the mare the length ranges from 35 to 40 inches, 
the amniotic portion representing about one third of the total 
length. It is sufhcientlj' long that, when a foal is normally 
born and the dam is in the recumbent position, the cord remains 
intact and may even persist after the mare has risen to her feet, 
but ruptures when she turns her head to the foal, to lick it, or 
starts to move away from it. Sometimes the foal, by its strug- 
gles, ruptures the cord by its own efforts. In other cases, the 
cord remains intact and the chorion is completely expelled, still 
attached to the living foal, and its rupture takes place after the 
foal rises to its feet. 

The point of normal rupture of the navel cord of the foal is 
about ij^ to 2 inches from the umbilicus, at a well marked con- 
striction. This delimits the cord proper from what may be called 
the tmibilic base, or cutaneous navel, a hairless, cylindrical, firm 
segment 1 to lyi inches long. At the termination of this por- 
tion a softer and more fragile cord begins with a somewhat con- 
stricted neck and, within this latter at a point % inch or more from 
the base, the rupture of the cord generally occurs. (See Fig. 
90 B.) 

The navel cord of the cow consists of an amniotic portion only 
and is less than }i the length observed in the mare, ranging be- 



365 Veterinary Obstetrics 

tween ii and i6 inches or ^ to ^ the length of the fetus, a 
difference which regularly leads to its rupture during the ex- 
pulsion of the fetus and only rarely permits the birth of the calf 
with the cord intact. Hence, in the cow and other ruminants, 
not only is the fetus born naked, as already related, but during its 
expulsion the rupture of the cord usually frees it completely from 
all fetal annexes. 

In the pig, the umbilic cord is wholly amniotic and very long, 
equal to the entire length of the fetus, while, in carnivora, the 
cord is short and very resistant, so that eventually it is usually 
bitten in two by the mother. 

In relation to diseases of the new-born, it should be noted in 
reference to the various structures of the umbilical cord that, 
when it is permitted to rupture naturally, the umbilical arteries 
quickly retract within the abdominal cavit}^ and draw along with 
them, in an inverted manner, the loose connective tissue surround- 
ing them. It has been claimed by some, apparently on insuffi- 
cient grounds, that, in the cow, etc., the arteries rupture within 
the abdomen. This retraction of the arteries accomplishes two 
important purposes : it draws their wounded ends away from the 
exterior, preventing the entrance of infection into them, and the 
inverted connective tissue which is drawn back with them, offers 
an impassable barrier to hemorrhage. The retraction of these 
arteries also causes a thickening of their walls, as their length 
decreases, and thus serves to narrow and virtually obliterate their 
cavity. (See Fig. 56.) 

The umbilical vein remains open for a time and serves as an 
avenue for infection. This fact is highly important in relation 
to the well-being of the young, since, through this portal, serious 
infection frequently occurs to constitute the disease known as 
navel infection or omphalo-phlebitis. The urachus, too, may re- 
main open (pervious urachus) or become re-opened a few days 
after birth through the agency of infection, much as arteries re- 
open to constitute secondary hemorrhage from infected wounds. 

The Whartonian gelatine, if retained in the cord by means of 
a ligature, serves the dangerous purpose of a culture medium for 
bacteria. When the cord is normally ruptured, the Whartonian 
gelatine quickly oozes from the broken surface, the stump of the 
cord soon dessicates, the wound occasioned by the rupture 
becomes hermetically sealed and, from that moment on, infection 
is excluded. 



TERATOLOGY. 

Teratology is the science of monstrosities, or aberrations in 
the development of the embryo. The subject is too extensive 
for any definite consideration in a treatise upon obstetrics. The 
extent of deviation from the normal may be of every gradation. 
There may be merely a perceptible deviation from the normal, 
which we usually designate a defect, or arrest, in development. 
Or the deviation from the normal may be so extreme as to result 
in an almost shapeless mass, such as the acardia, or " mole", 
illustrated on page 289, or a double monster such as is illustrated 
in Figs. 126 and 127. Such deviations are known as monsters 
and, as a general rule, the departure from the normal is such 
that it prevents the animal from living after birth or compromises 
the existence of the mother in the act of birth, so that such ab- 
normal individuals are rarely born alive or, should this occur, their 
defects in structure are such as to nearly always cause their early 
death. In the lesser deviations from the normal, we sometimes 
fail to observe the defect at the time of birth and it is only when 
it has caused disease that we are led to note the 'fundamental de- 
fect in development. Such is well illustrated by the defects of the 
teeth, which are mentioned on page 314. 

In the preceding chapter, under the head of Embryology, we 
have mentioned numerous forms of monstrosities and defects in 
development in order to draw a contrast between the normal 
embryological development and the abnormal, or teratologic, de- 
velopment. We have also aimed, in that chapter, to point out 
the causes of these deviations, so far as they are well known, 
and to forge a connecting link between teratology and disease. 
Neither have we attempted to give an extended account of embry- 
ologj', but have aimed to aid the veterinary student, as far as 
possible, to get the logical connection between embryology and 
the subjects of obstetrics and surgery. The veterinary obstet- 
rist needs know, so far as possible, the embryologic foundation 
of certain defects, and of diseases arising from these in our do- 
mestic animals, because intelligent handling of these must be 
based upon such an understanding. 

We shall have further occasion to refer to some forms of aber- 
ration in development when dealing with the subject of dystokia, 
since some of them lead to very great difficulty in parturition and 
tax to the utmost the resources of the obstetrist. We shall again 

367 



368 Veterinary Obstetrics 

have occasion to mention some of these aberrations in develop- 
ment when deahng with the defects of the new born animal. 

While the subject of teratology is one of very great scientific 
interest and serves largely to emphasize the facts of embryo- 
logy and the regularity with which the development of the 
embryo ordinarily proceeds, we must content ourselves, in this 
treatise, with a bare mention of the subject. Teratology was first 
placed upon a scientific basis by Gurlt (Lehrbuch der patho- 
logischen Anatomic, 1831) and later the science was expanded 
by Saint Hilaire and others. 

Experimentally, teratologj' has also received a considerable 
amount of attention and it has been found that the chick embryo 
and others which are readily available for manipulation may be 
caused to undergo a great variety of aberrations during the early 
stages in development, by mechanical disturbances. The con- 
clusion has been reached, from these experiments, that accidents 
of a somewhat similar character, occurring during the very early 
stages of embryonic development in our higher animals lead also 
to aberrations in development. 

It is worthy of remark that those arrests in the development 
which have occurred early in the life history of a given embryo 
show a marked tendency to recur in the offspring of the defective 
organism, when it lives to the breeding age. This may readily 
occur in the milder forms of aberration in development, but it is 
only rarely that the more serious ca.ses, which we generally speak 
of as monstrosities, are capable of breeding, or even of surviving 
to the adult period. In the lesser aberrations in development, 
such as arrests in the closure of the umbilic or inguinal rings, 
resulting in hernia, the defect is extremely liable to become 
fixed and to be reproduced with disastrous frequency in the off- 
spring of such an animal. 

Among the laity, the occurrence of mon.strosities arouses more 
or less mysticism and they are frequently attributed to some 
psychic influence upon the pregnant mother, usually at some 
late period in gestation, when the defect has already long been 
fixed in the fetus, having occurred at a very much earlier date. 
On the other hand, it is highly probable that teratology itself 
has had an important influence upon mythology and may have 
played an important part in such myths as the Cyclops, the 
Janus and others, which myths find accurate representatives 
among the monstrosities in man and in animals. 



PREGNANCY, OR GESTATION. 

By the term gestation we comprehend that period of time dur- 
ing which the young is undergoing development in the uterus of 
the mother, a period extending from the time of the fertilization of 
the ovum until the birth of the fetus. 

The modifications which necessarily take place during this 
period are of a very profound character, and exert an im- 
portant influence upon the life and nutritive powers of the 
mother. 

The volume of the uterus becomes very greatly increased. The 
walls of the non-gravid organ are contracted and firm and its 
cavity is insignificant, the mucous membrane of the walls being 
in contact. As soon as impregnation occurs, the uterus must 
become very greatly increased in volume in order to accommodate 
the fetus and its membranes. Even prior to impregnation, during 
estrum, the uterus has undergone some degree of enlargement 
and intensified function preparatory to the fertilization and 
nutrition of the ovum. Consequently, impregnation in a way 
continues and accelerates this increase in volume until it 
reaches its maximum at the time of parturition. 

The first notable change in the uterus, which has already been 
anticipated during estrum, is the greatly increased vascularity 
of the organ, both of the walls and the mucosa. The mucous 
membrane becomes especially vascular, as is shown by its deeper 
color and its great increase in thickness, as well as by a softening 
of the membrane. 

The increased function in the mucosa is not equally apparent in 
all parts, but is most pronounced in those regions where the 
attachment of the fetal placenta is to occur. Thus, in the 
ruminant, the principal increase in activity and growth of the 
mucosa is at those points which are to constitute the cotyledons 
of the gravid horn, while, in the mare, it is more evenly distri- 
buted over the entire organ. In the bitch and cat, it is largely 
concentrated in that part which is to enter into relations with 
the placental zone of the fetus. 

In multiparous animals, like the bitch, cat and sow, the 
uterine cornua become enlarged and bulged at the points where 
the impregnated ova have lodged and become attached to de- 
24 369 



370 Veterinary Obstetrics 

velop into embryos. This arrangement results in a nodular 
form suggesting the general appearance of a rosemary, the nodes 
in the elongated organ being usually quite equally distributed 
throughout the entire length of the tube. In the uniparous 
animal, in wjiich the fetus, as a rule, is lodged partly in the 
■cornu and partly in the body of the uterus, the gravid cornu and 
body increase far more rapidly in size and undergo greater 
changes in structure than the non-gravid or vacant cornu. 

The blood vessels of the uterus undergo very rapid growth 
during pregnancy. The non-gravid uterus is firmly contracted 
and shows no great vascularity, so that operations upon it may 
not be accompanied by great hemorrhage. When pregnancy 
occurs, the arteries and veins very rapidly enlarge and increase 
to many times their former volume, so that any injury or 
wound of these vessels tends to cause more or less .serious 
hemorrhage. 

The density of the non-gravid organ, serves to differentiate 
it from the intestines and other abdominal viscera, because 
of its firmness upon palpation. During pregnancy this 
density decreases very greatly and the organ soon comes to re- 
semble, to the sense of touch, the intestines. This is very 
markedly the case in the pregnant bitch, in which this change 
in the density of the organ causes it, so far as the sense of touch 
reveals, to so closely resemble the intestine as to occasionally 
embarra,ss an operator when spaying a bitch which is unex- 
pectedly pregnant. This decrease in the density of the organ 
is attributed partly to the thickening and softening of the 
highly active mucous membrane, partly to the enormous in- 
crease in the number and volume of the arteries and veins 
and partly to a relative decrease in the thickness of the walls 
of the organ, owing to its very rapid distension, in which process 
the growth in comparative thickness fails to keep pace with the in- 
creased area. In the non-gravid uterus, there is present in the con- 
tracted organ a reserve of tissue, which must later undergo very 
rapid development. The non-gravid cornu is usually 50 to 
100% thicker than the gravid cornu. 

The glands in the uterine mucosa become rapidly elaborated ; 
the utricular glands become enlarged, they increase in length and 
width and their secretions become augmented. In the ruminant 



Pregnancy, or Gestation. 371 

the uterine cotyledons develop rapidly and it has been shown 
that new ones appear. Rainard could distinguish but 30 to 40 
cotyledons in the uteri of heifers or lambs, while, after parturi- 
tion, he found 100 or more. It has further been shown by the 
experiments of Colin and others that, if the cotyledons have been 
artificially removed from a cow, new ones form during the period 
of pregnancy. In the mucous membrane of the uterus, there also 
form crypts, at an early period in pregnancy, into which the villi 
of the fetal chorion grow and become attached. These crypts 
are the counterpart of the villi of the chorion and vary in their 
form and complexity according to the species of the animal. 
They are lined with a thin layer of epithelium, immediately be- 
neath which are the uterine capillaries, in a rich net-work. In 
the mare these crypts are distributed over the entire uterine sur- 
face, in harmony with the distribution of the villi of the chorion, 
while in the cow they are limited to the cotyledons and consti- 
tute essentially the mass of these organs during pregnancy. In 
those animals having zonular placentae, they are confined to 
the placental zone. 

Between the mouths of these crypts, utricular glands open 
upon the surface of the mucous membrane and pour out their 
secretions, the uterine milk. (See Fig. 78.) 

Investigations have shown that during pregnancy the muscle 
fibers of the uterus become increased in size and multiplied in 
numbers, so that the increa.sed volume of the organ is not wholly 
dependent upon increased function in some of the muscle cells, 
but partly upon a multiplication of the muscle fibers. The 
lymphatics and nerves also increase in extent and volume during 
pregnancy. 

The broad ligaments of the uterus become increased in 
their length and thickness and their muscle fibers in volume. 
Fleming asserts that the muscle fibers are increased in order 
to give them sufficient strength to sustain the weight of the 
greatly enlarged uterus and its contents. This cannot be cor- 
rect, because the gravid uterus lies upon the floor of the abdomen 
and does not swing in the ligaments. The increase in the extent 
and strength of the broad ligaments should be attributed rather to 
the necessity for their maintaining their relations with the uterus 
in its changed position and for preventing their rupture during 



372 Veterinary Obstetrics 

movements of the organ. In themselves, the ligaments would not 
suffice to sustain the weight of the gravid uterus, but they per- 
form an important office in tending to keep the uterus in its nor- 
mal direction along the abdominal floor. It should be constantly 
borne in mind, however, that the parietal attachments of the 
broad ligaments do not change during pregnancy and neither 
advance nor retreat. It is also to be noted that the gravid uterus 
grows forward constantly and advances beyond the anterior attach- 
ment of the broad ligaments to the abdominal walls, and that it 
is because of this that torsion of the uterus can occur. 

The 3en.sibility of the uterus is increased, presumably because 
of a heightened development of the nerves of the organ. Upon 
opening the bodies of pregnant animals under anaesthesia, or im- 
mediately after death, the uterine walls undergo very marked 
contractions, which closely resemble the peristalsis of the intes- 
tines. These uterine contractions, or peristalsis, are e.specially 
marked in the pregnant bitch or cat, where there are alternate 
constrictions and dilations due to alternating contraction and 
relaxation of the circular fibers, while the part taken by the lon- 
gitudinal muscle fibers is shown by an alternating increase and 
decrease in the length of the uterus. 

The sympathy between these uterine contractions and the 
other parts of the genital apparatus is shown in a variety of ways. 
It has been generally believed that copulation, in case of the 
pregnant female, tends to produce sympathetic contraction 
of the uterus, with an expulsion of its contents, or abortion. In 
manipulations of the pregnant uterus, we constantly consider 
that we should be very gentle and careful lest we induce con- 
tractions which will end in the death and expulsion of the fetus. 
Hess has asserted, moreover, that artificial abortion is readily 
and uniforml}' induced by the dislodgement of the yellow bodies 
from the ovaries by manual compression per rectum. It is a 
common experience that the removal of the ovaries, or castration, 
of the pregnant female tends constantly to induce abortion. 
This contractility of the uterus during pregnancy probably has 
an important relation to its functional activity and the nutrition 
of the fetus, and tends to maintain the fetuses in their proper 
position and direction by correcting any chance displacement 
caused by any sudden movements of the body. 



Pregna7icy , or Gestation. 373 

These contractions are important for the development of the 
power in the uterine walls which finally assumes a very necessary 
function at the time of parturition, because it is largely 
through these that the os uteri is dilated and the fetus is ex- 
pelled. It is notable that it is in the multipara, where the uterus 
is long and tubular, that the uterine contractions play the great- 
est part in the expulsion of the fetuses, while, in the unipara, 
like the mare and cow, the principal expulsive powers at the 
time of parturition reside in the abdominal walls and the uterus 
performs a less conspicuous part in the act of birth. 

After the expulsion of the young from the uterus, it is again 
highl)' important that there should be a vigorous contractile 
power in the organ, in order that it may expel, at an early period, 
the fetal membranes and such portions of the uterine epithelium 
as are cast off. It is needful that the walls should contract 
vigorously in order to check the amount of blood passing to the 
■organ and to close all capillaries in the uterine mucosa which 
have been opened during the process of separation between the 
fetal membranes and the uterus. It is also important that the 
uterine cavity shall be promptly closed and the epithelium of 
its walls brought in contact. This contraction, too, indirectly 
€xerts a disinfecting, or bactericidial, power and serves to prevent 
the entrance of infection or overcome any infection which may 
have gained entrance into the cavity during or immediately after 
the expulsion of the fetus. 



THE FORM OF THE PREGNANT UTERUS. 

The gravid uterus undergoes important changes in its form, 
since it must adapt itself to the form, volume and position of the 
fetus or fetuses and especially to the membranes which surround 
them. In the multiparous animals, we have already stated that 
the fetuses are distributed somewhat equidistant from each other 
throughout the length of the cornua and that, 'at the points 
where they develop, the organ becomes enlarged, while between 
them it is constricted so that it gives the organ a nodular 
appearance. In animals, like the mare and cow, which usually 
produce but one young at a time the uterus assumes a somewhat 
oblong or globular form. In uniparous animals the fetus is usu- 
ally contained in the uterine body and one horn, so that the princi- 
pal changes take place in those parts and leave the uon-gravid cornu 
but slightly increased in size or changed in form, so that it appears 
as a mere appendage upon the side of the enlarged cavity which 
contains the fetus. In the multiparous animal, whether there 
be several fetuses or only one, the development of the young oc- 
curs in the cornu or cornua and the so-called uterine body regularly 
remains empty and serves merely as a passage for the fetus from 
the point of its development, when the time for parturition 
arrives. In rare cases in multiparous animals, not infrequently 
in the mare, a fetus may develop more or less equally in the two 
cornua, bicornual pregnancy, and, at the time of parturition, offer 
serious or fatal obstacles to birth. (See Transverse or Bicornual 
Pregnancy.) Usually, in multiparous animals, the number of 
fetuses is approximately equal in the two horns. 

The cervix of the uterus undergoes well-marked changes dur- 
ing the latter part of pregnancy. During pregnancy the os 
uteri is firmly closed by the constriction of the circular muscle fibers 
of the cervix and the occlusion is further secured by means of an 
albuminous clot, which is quite thick and firm. The cervix is at 
first quite firmly contracted, so that it is exceedingly dififi cult to 
force a passage through it into the uterus of the cow, while, in 
the mare, as in the non-pregnant state, it is very easily dilated 
and one or more fingers or the entire hand may be inserted. 

As parturition approaches, the os uteri normally becomes 
somewhat dilated. The walls of the cervix become softer and 

374 



The Form of the Pregnant Uterus yi^ 

more distensible and the longitudinal folds of mucous membrane 
begin to disappear. Finally, when labor begins, the os, under 
normal conditions, dilates until it becomes completely effaced 
and is of the same dimensions as the vagina and uterus, so that 
the two cavities now become continuous, with no distinct line of 
demarcation between the two portions. After parturition has 
occurred, the os and cervix normally resume their previous 
condition very promptly, so that within a few days these parts 
are approximately the same as before impregnation. 

The situation of the uterus is modified by the changes taking 
place in its volume. At the same time, its growth must alter 
in some degree the situation of other floating viscera. The 
gravid uterus possesses the highest specific gravity among the 
floating organs of the abdominal cavity and, as a consequence, 
in our quadrupedal animals it soon descends to and rests upon the 
abdominal floor. Its position upon the abdominal floor is slightly 
modified in some cases by neighboring organs, when they are 
sufficiently voluminous and possess a high specific gravity, like 
the rumen of ruminants and the great colon of solipeds. As a 
result, in the mare the pelvic flexure of the colon is displaced 
somewhat to the right and the uterus passes along beneath it 
to the left of the median line. In ruminants, on the other hand, 
the uterus becomes slightly displaced to the right by the enormous 
rumen. In the multiparous animals, none of which have any 
very voluminous floating viscera, the gravid uterus becomes the 
most important abdominal organ and takes first place along the 
median line, displacing the other viscera to either side or upward. 

The.se changes come about somewhat slowly. At first the 
gravid uterus rests partly in the pelvis and well suspended by 
the broad ligaments in the sublumbar region, but, as soon as the 
fetus has acquired any great volume, it at once bears the uterus 
downward and forward onto the abdominal floor and finally 
pushes its way along this, as on an inclined plane, until it reaches 
the diaphragm, where the most anterior extremity of the gravid 
uterus lies in close relation with the stomach, liver and dia- 
phragm. 

During this change in the position of the uterus, the os uteri 
is for a time dragged forward so that it is farther from the vulva 
than in the non-pregnant animal, but later, in unipara, when the 



376 Veterinary Obstetrics 

fetus has come to rest against the diaphragm and has acquired a 
longitudinal diameter which equals or exceeds that of the 
abdominal cavity of the mother, the more posteriorly situated 
end of the fetus, with its membranes, pushes up into the pelvis 
to the OS uteri. The os uteri may itself be pushed back toward 
the vulva, and in some cases, when parturition is near, especially 
in the cow and ewe, the os uteri becomes displaced backward to 
such a degree that it may even appear between the lips of the 
vulva when the animal is lying down. This prolapse of the 
vagina and cervix in pregnant ruminants sometimes requires the 
attendance of the obstetrist. See Ante-partum Prolapse of the 
Vagina. 

On the other hand, in some animals with exceedingly pen- 
dulous abdomens, or in that pathologic condition where rup- 
ture of the abdominal floor has occurred so that the fetus passes 
through the muscular floor of the abdomen to rest against the 
skin, the uterus is dragged abnormally downward and forward 
so that the vulva and anus are drawn inward and present a con- 
cavity. 

In multiparous animals the uterus lies folded upon itself ver}- 
much the same as the intestine. Fleming states that, in the pig, 
each cornu of the uterus lies above the corresponding line of 
mammae. This, however, is impossible, sibce, when there are 
6 or 7 fetuses in one cornu, their combined length is at least 
double that from the pubis to the diaphragm. Consequentlj', 
they cannot be arranged in a straight line, but the cornu must 
be thrown into folds to accommodate the disposition of the 
fetuses contained within it. 

The direction of the uterus in our domestic animals is very 
simple. Its weight and the horizontal position of the body tend 
constantly to keep it in an antero-posterior direction, in a general 
line with the long axis of the body, modified only in those cases 
of multiparous animals, in which the cornua are too long to lie in 
a direct line, and in the larger herbivora, in which the uterus 
may be slightly displaced to the right or left by great viscera. 

In those animals like the cow and mare, in which the ab- 
domen maj' be verj^ pendulous, there may be a somewhat marked 
deviation of the uterus downward, which would cause the os 
uteri to present somewhat upward, but this is not of such a 



The Fortn of the Pregnant Uterus 377 

character as to be termed abnormal and forms no particular im- 
pediment to labor. In other cases, the uterus becomes displaced 
on account of the ruptured prepubian tendon (which see) or it 
may become rotated upon its long axis, inducing torsion of the 
uterus, which we shall consider later. 

The influence of the gravid uterus upon neighboring organs 
is comparatively unimportant except in a purely mechanical way. 
It does not interfere materially with any of the abdominal 
viscera. When the fetus attains considerable size and rests 
against the diaphragm, it may mechanically impede respiration 
to a slight degree. 

The influence of the gravid uterus upon the circulation of the 
region has been claimed by 'Some writers to be quit^ important. 
Fleming states that, in the cow and mare, the gravid uterus ex- 
erts an unfavorable compression upon the blood vessels of the 
hind limbs, vulva and rectum and causes engorgement of the 
veins and lymphatics in these parts. In this way he accounts 
for the edema of these parts so often observed in the later stages 
of gestation in the mare. He thinks, also, that this edema is re- 
ferable to some extent, in the mare and cow, to pressure upon the 
saphena and mammary veins. It would be exceedingly difficult 
to demonstrate this hypothesis upon anatomical grounds. In 
woman, in her upright position, with the head of the fetus 
normally resting against the pelvic inlet and the entire weight 
of the fetus bearing upon these parts, it would seem reasonable 
to expect some interference with the return of blood from the 
inferior extremity of the mother, and this is clinically true. 
However, in our domestic animals in their quadrupedal position 
this cannot well follow. In dropsy of the amnion in the cow 
(which see), there is such a great collection of amniotic or 
allantoic fluid that the patient is borne down by* the immense 
weight and cannot rise to her feet. Still, in these cases, dropsy 
of the limbs is never seen, but they are on the contrary very clean 
and free from any edema whatever. Both from an anatomical 
and a clinical standpoint, the allegation that compression \>y the 
gravid uterus causes edema of the posterior limbs and abdom- 
inal floor is questionable ; the edema should probably be referred 
to other than mechanical influences. 

The changes in volume, weight and position of the gravid 
uterus, while they bring about some alterations in the position 



378 Veterinary Obstetrics 

of other viscera, do not interfere materially with their functions. 
The modifications in position necessitated by the growth of the 
uterus come about gradually, so that the other organs readily 
adapt themselves to the change, without inconvenience. 

The increased weight of the body contents, which has become 
greater in pregnancy, necessarily hampers somewhat the move- 
ments of the mother, so that she is slower and less agile. It 
may be also that there are ps5'chic reasons which cause her to 
move more slowlj' and carefully, lest there should be danger of 
injury to herself or her fetus. 

Very early in pregnancy, important psychic changes occur. 
In the mare, especially, it is noted that there is greater docility 
and that the animal seems somewhat- more sluggish. Both the 
mare and the cow, toward the latter part of pregnane)-, show some 
arousing of the maternal instinct and are more ready to defend 
themselves in event of danger. This is especially noted in the 
cow upon the approach of carnivorous animals, which, in the 
natural state, constitute her enemies. 

In domestic animals we do not observe those disturbances in 
the digestive and nervous systems which are seen at the com- 
mencement of pregnancy in woman. As a general rule, the 
pregnant female is more quiet and contented than the non- 
pregnant and, during the first half of pregnancy, takes on flesh 
rapidly upon a comparatively light diet, but later in gestation 
shows a tendency to lose flesh, because of the great drain upon 
the maternal system due to the rapid growth of the fetus. This 
tendency to fatten during the early stages of pregnancy is used 
by stock-feeders to hasten the fattening process of animals in- 
tended for slaughter. The animals are habitually bred at a 
favorable time and then sold upon the market before they have 
reached the middle stage of gestation. 

Fleming states that the pressure exerted by the uterus upon 
the vagina and the neck of the bladder causes the animal to 
urinate more frequently, but this is not noticeable clinically. 
Probably this thought is suggested by the clinical fact observed 
in pregnant woman, in whom, owing to her position and that 
of the fetus, there is direct mechanical compression of the urinary 
bladder. The volume of blood in the body of the pregnant 
female is said to be positively increased, but its corpuscles and 
solid constituents relatively decreased. 



THE POSITION OF THE FETUS IN THE UTERUS. 

The position of the fetus or fetuses in the uterine cavity is 
largely determined by the form and direction of the cavity itself 
and the form and specific gravity of the fetus. Since these 
factors are reasonably constant in each species, it follows that 
the position of the young in the uterine cavity is also quite 
uniform. 

It is not always easy to determine precisely the position of the 
fetus in the uterus, by post-mortem examination, because of the 
fact that the fetus and uterus probably change their position 
somewhat according to that of the maternal body. We have al- 
ready stated above that the gravid uterus possesses the highest 
specific gravity of any of the abdominal vi.scera. The fetus also 
offers the highest specific gravity among the uterine contents 
and, this being true, it follows that the po.sition of the fetus 
should always be stable, independent of its umbilic attachments. 

In the development of the embryo, the head-end grows much 
more rapidly during the first stages of embryonic life than the 
posterior portions. The circulation of the fetus is so distributed 
that more arterial blood reaches the anterior than the posterior 
end of the embryo, especially during the early stages of fetal life: 
The brain grows very rapidly and the dorsal surface of the bodj' 
outgrows the ventral, so that the embryo is soon arciform. The 
great development of the head-end of the embryo, as compared to 
the posterior, causes the anterior portion to possess greater weight, 
which would constantly tend to cause the embryo, if suspended, 
to rest with its head-end lower than the posterior part of the 
body. The arciform character of the fetus continues throughout 
intra-uterine life and, from the beginning, affects the stability of 
the position of the fetus. 

The fact that the uterine cavity of each of our domestic animals 
is more or less tubular in form renders it essential that the long axis 
of the fetus should correspond to the long axis of the uterine 
cavity, so that regularly the fetus is found resting in this position. 
Exceptions to this rule occur in the uterus of the mare and, more 

379 



380 Veterinary Obstetrics 

rarely, in other animals in which a single fetus develops more or 
less equally in each of the two cornua, but even in this instance 
the rule is followed in a measure by the fetus being placed 
longitudinally in the combined cavities of the two cornua. This 
compels the fetus to assume a transverse position in- relation to 
the long axis of the body of the mother and of the body of the 
uterus. The question of the development of the fetus in the 
two horns is discussed under " Bi-cornual Pregnancy." 

The question of the presentation of the anterior or posterior 
end of the fetus toward the os uteri is largely determined, so 
far as we know, by the inclination of the uterus and comparative 
specific gravity of the head and tail ends of the fetus. Early in 
embryonic life, as we have already related, the fetus floats free 
in the amniotic sac and may turn upon its short axis, so that 
either the head or tail may present toward the os uteri. In the 
mare and carnivora there is further facility afforded for the fetus 
to turn upon its short axis, b}' the complete allantoic sac. This 
entirely surrounds the 'amniotic sac, so that the fetus with its 
amnion may turn within the allantois. Turning upon the 
short axis must necessarily cease as soon as the long axis of the 
fetus exceeds the transverse axis of the uterine cavity. The 
fetus then becomes fixed, so far as its antero-posterior diameter 
is concerned, for the remainder of its intra-uterine life. 

In the uniparous and biparous animals, the bases of the 
uterine cornua slope more or less backward and downward from 
their anterior attachments toward the os uteri and maintain 
this position until the weight of the fetus and its membranes, 
with that of the contained fluids, bears the organ down to the 
abdominal floor. During this period, prior to the descent of the 
uterus upon the abdominal floor, the head-end of the fetus is 
much the heavier and consequently tends to become directed 
toward the os uteri. A further influence in reference to the 
position of the fetus is the question of the form of the uterine 
tube itself. This tube is not uniform in its transverse diameter, 
but is tapering and becomes smaller as the oviducts are approached, 
so that again the tendency would be for the larger end of 
fetus to occupy the larger end of the cornu, which would cause 
the head-end to present toward the os uteri. 

In multiparous animals, in which the uterus lies upon the 



The Position of the Fetus in the Uterus. 381 

abdominal floor at a very early period in pregnancy, the question 
of the inclination of the uterus can have less influence upon the 
direction in which the head-end shall present than in the uni- 
para, and so we find that they present somewhat indifferently 
though the tendency for the head-end of the fetus to present 
toward the vulva is still well marked. 

Late in gestation, the hinder parts of the fetus become more 
developed, so that in the larger herbivora these parts equal or 
exceed in bulk and weight the anterior portions of the body. 
By this time the uterus is lying upon the abdominal floor and 
the posterior part of the fetus occupies the lowest point of the 
abdomen in the neighborhood of the diaphragm. In addition to 
this, the fetus has acquired a longitudinal diameter which is 
in excess of the transverse diameter of the uterine cavity, and 
the relationship between the long axis of the fetus and that of 
the uterine cavity becomes fixed and permanent. 

We thus find that, in the vast majority of cases in our larger 
domestic animals, the fetuses regularlj' present anteriorly at the 
time of birth. In multiparous animals, the fetuses present some- 
what indifferently, usually anteriorly, frequently posteriorly. 

The relationship between the transverse axis of the fetus and 
that of the maternal body is largely determined by the form of the 
fetus itself and of the surface upon which it rests. We have already 
learned that the fetus early assumes the form of an arc and that this 
form is maintained throughout its intra-uterine life. The fetus 
bends ventralwards and its form inhibits any marked dorsal flexion . 
During the early stages of gestation, the uterus is suspended by 
its ligaments in the abdominal cavity and its cornua in the mare 
are more or less curved downward at their middle portion. In 
ruminants the gravid cornu or cornua retain for a time their uon- 
gravid spiral form, curving downwards, backwards and then 
upwards. An arciform fetus would normally assume the most 
stable position, which would be with its convex or dorsal surface 
applied to the convex side of the uterus and its concave or ven- 
tral surface toward the concave uterine surface. 

At this stage the natural position of the fetus in the mare is with 
its dorsum downward and its ventral surface upward. In the 
ruminant, so long as the uterus remains in its non-gravid position, 
the ventral surface of the fetus would normally present down- 



382 Veterinary Obstetrics 

wards, if in the base of the cornu, to correspond with the concave 
side of the uterus. 

As the weight of the fetus increases and bears the uterus 
downward to the abdominal floor, the position of the arciform 
fetus becomes unstable because it tends to come to rest, lying up- 
on its convex dorsal surface, upon the essentially plane abdominal 
floor. Its position would be equally unstable should it settle 
against the abdominal floor upon its ventral or concave border, 
as might occur in the ruminant. Either of these positions is so 
unstable that the fetus tends to revolve upon its long axis 
and finally come to rest in a more or less lateral recumbent posi- 
tion. Hence, during the later stages of pregnancy, the fetus is 
generally found lying somewhat upon its side along the abdomi- 
nal floor, where it may be readily felt, through the flank, in our 
larger animals. 

In ruminants, the downward, forward, and finall}' backward, 
curvature of the uterine cornua leads to instability of the fetal 
position and, as the fetus acquires weight and descends to the 
abdominal floor, it must assume a stable attitude and, instead of 
resting upon its ventral surface with its concave border down- 
wards, must turn upon its side and come to rest upon the abdomi- 
nal floor. In so doing, the gravid cornu tends to revolve slightly 
upon its long axis. 

The attitude of the fetus is largely determined by its form and 
the available space for its accomodation. In the cow and mare, 
the abdominal cavity is not sufficiently long to accommodate the 
fetus in an extended position and it must consequently be doubled 
up in a way to occupy a minimum amount of space antero- 
posteriorly. This condition is most completely fulfilled by the 
head and neck bending ventralwards so that the chin comes 
in contact with the sternum ; the anterior limbs flexed at the 
elbow and carpus so that the anterior feet rest with their ventral 
surfaces against the chest, the carpus being in contact with the 
sides of the head, and the posterior limbs, flexed at the stifle and 
tarsus, folded beneath the body in approximately the same posi- 
tion as is observed in sternal recumbency of the adult animal. 

In the multiparous animals, the fetuses rest in a more direct 
line, there being much less curvature in the long axis, especially 
toward the termination of pregnancy. The limbs, being shorter 



The Position of the Fetus in the Uterus. 383 

and less conspicuous than in the larger animals, are more fre- 
quently extended and the neck, being very short, is not curved. 

When parturition approaches and the fetus of the uniparous 
animal has well-nigh outgrown the available room in the abdomi- 
nal cavity, the presenting end of the fetus pushes up to, or into, 
the pelvic cavity and is readily felt by manual exploration per 
vaginam or per rectum. In the cow, the fetus having a com- 
paratively short neck, the head is frequently extended a few 
days before parturition, pushes up into the pelvic cavity and, 
extending over the top of the vagina by pushing the superior 
wall of the uterus backward, it appears to the inexperienced 
veterinarian to be outside the uterus, although in reality the 
position is not rare and not abnormal. Along with the head, 
there may present also, in these cases, two anterior feet, extended. 
We have not observed this attitude of the fetus in the mare, 
although it may occur. 

At the termination of pregnancy, the fetus changes its position 
and, when it begins to move toward the pelvic inlet, as a result of 
labor pains, it normally revolves slightly upon its long axis and, 
changing from lateral recumbency, presents with its dorsum 
toward the lumbar vertebrae of the mother and its ventral surface 
toward her pelvic floor. This is essential in relation to the 
resistance offered to the passage of the fetus through the pelvic 
canal. Whenever it presents otherwise than with the dorsal sur- 
face corresponding to the spinal column of the mother, it causes 
great or insuperable difficulty in expulsion and calls for a version 
of the fetus upon its long axis before delivery can readily occur. 
This difficulty arises from the fact to which we have already al- 
luded, that the fetus maintains the form of an arc, the ventral 
surface being concave. The direction of the roof of the passage 
through the pelvis is also somewhat arciform, with its concavity 
downwards, so that the arciform fetus can readily pass only in the 
one position and a very great obstacle is offered to its passage when 
its dorsum is directed downward or to the right or left, its arci- 
form body becoming impacted against some portion of the 
maternal passage. 



SIGNS OF PREGNANCY. 

It is of great importance in many cases to determine the ex- 
istence or non-existence of pregnancy. In the examination of 
mares in case of sale, it becomes highly important that the 
veterinarian should be able to determine definitely if the animal 
be pregnant or not. If desired for breeding purposes, the 
greatest proof that can be established of the breeding power of 
a female animal is the fact that she is pregnant. When 
a mare is being purchased wholly for work it is important 
to determine in advance if she is pregnant or not, since the 
condition of pregnancy may interfere seriously with her 'useful- 
ness. In the cow also it frequently becomes desirable to determine 
for the owner or prospective buyer whether pregnancy exists or 
not. In cows which are used for dairy or breeding purposes, it is 
essential that they be capable of breeding and it is frequently a 
very important question to the owner to decide whether a cow 
shall be retained for breeding or dairy purposes or whether she 
shall be sold to the butcher as sterile, and this can only be de- 
termined either by an intelligent investigation by the veterinarian 
or by awaiting the time for parturition to occur, which latter 
method may occasion a very considerable loss to the owner because 
of the delay. 

In all animals, it is important that we should be able to 
differentiate between pregnancy and certain diseases, which may 
more or less closely simulate that condition. 

There are many signs of pregnancy which have more or less 
value, but the vast majority of them are somewhat erratic and 
liable to mislead. It not infrequently occurs that an animal is 
regarded as pregnant for a long period of time and presents the 
general appearance of that condition, but finally fails to bring 
forth young, while in other cases, which may be even more de- 
deceptive, there are but slight external appearances of pregnancy 
and the owner is surprised when parturition unexpectedly occurs. 

The veterinarian should consequently be able to speak 
positivel}^ regarding the question of pregnancy in a domestic 
animal and, doing so, he needs to know and consider all symptoms 
or signs which have any relation to the question. 



Signs of Pregnancy 385 

The diagnosis of pregnancy during its earlier stages is exceed- 
ingly difficult and, during the very earliest period, is impossible. 
The symptoms of pregnancy may be divided into three principal 
groups ; the subjective or physiologic signs ; the objective signs ; 
and the positive or direct signs, which are observed by ex- 
amination of the parts in a way to definitely determine the pres- 
ence of the fetus itself. 

Physiologic or Subjective Signs. 

Some of the physiologic, and psychic, manifestations of pregnancy 
are quite well marked, but tend in some cases to become decep- 
tive. The physiologic symptom upon which the greatest re- 
liance is placed is the cessation of estrum. As a general rule, 
fertilization stops the appearances of estrum very promptly and 
permanently throughout gestation. Estrum may not cease im- 
mediately upon fertilization, but continue to the close of the 
normal estrual period during which the impregnation has taken 
place. Perhaps in this case we should rather say that the 
estrum continues until ovulation and fertilization have occurred. 
In discussing the relationship between estrum and ovulation, 
we ventured to suggest that in some animals, if not in all, 
but especially in the cow, ovulation does not occur until 
near the close of the estrual period. Consequently fertil- 
ization does not take place until such time, and until then 
we cannot expect a cessation of estrum. In other words, 
copulation, even though it be eventually fruitful, does 
not mark the period of fertilization. However, it is generally 
noted that, if copulation occurs early during estrum and 
fertilization follows, the estrual period seems to be cut short. 

Not only do the symptoms of estrum usually disappear to not 
recur until after parturition has taken place, causing the female 
to persistently refuse copulation, but it is said by some observers 
that males themselves in many cases decline to copulate with 
females which are pregnant. This is not uniformly true by any 
means. Both in the mare and cow there are frequent cases in 
which the pregnant animal shows all the signs of estrum and in 
which prompt and repeated copulation occurs in an apparently 
natural way. This is especially true in nymphomaniac cows, 
which frequently show all the signs of estrum, at the regular in- 
25 



386 Veterinary Obstetrics 

tervals, after fertilization has occurred, and will continue to 
copulate regularly for two, three or more estrual periods, in spite 
of the existence of pregnancy. In a case which we personally 
observed, the cow was bred for three successive estrual periods, 
to a bull of one breed the first time, and to one of another breed 
during the last two periods, and finally gave birth to a calf at the 
proper time from the first breeding, which showed the character- 
istics of the breed of the first bull. Similar observations are 
made in all our domestic animals, though not so frequently as 
in the cow. 

It is quite generally believed that copulation in an advanced 
state of pregnancy is liable to induce abortion and numerous 
cases have been cited to apparently demonstrate the fact. In 
one case which we observed, the cow showed signs of estrum at 
about the close of the eighth month of pregnancy and was bred. 
On the following day abortion took place. The conclusion was 
that the copulation had caused the abortion. This may or may 
not have been true. The abortion may have been due to the 
same causes as the estrum, or we might say that possibly the 
abortion, or rather the death of the fetus preparatory to its ex- 
pulsion, had induced the signs of estrum and led to copulation 
with the male. 

While the cessation of estrum is an important indication of 
pregnancy, it is evidently not final nor wholly reliable ; a non- 
pregnant animal may cease to show signs of estrum, as we have 
already related when discussing sterility, while a pregnant one 
may show signs of estrum at any time during gestation and 
copulate freely with the male. 

In our domestic animals there is usually noted, as a conse- 
quence of impregnation, a more tranquil disposition of the 
female, as a result of which she tends to take on fat during the 
earlier stages of gestation and, as we have already remarked, 
this tendency is made use of in preparing animals for slaughter. 

Toward the close of pregnancy, anirnals apparently become 
lazy and are not capable of performing certain kinds of move- 
ments which require agility, such as running and jumping, with 
the same ease as those which are not pregnant. But these 
changes are not well marked and the mare which is kept regu- 
larly at work suffers but little inconvenience so long as the labor 



Sig7is of Pregna7icy 387 

is of a moderate character, that is, if the load to be drawn or 
carried, or the pace which is to be maintained, is not extreme. 

Physical or Objective Signs. 

The most important physical signs of pregnancy are those 
indicated by a change in the volume and form of the abdomen 
and mammae, accompanied by the secretion of milk, to which 
may also be added, according to some investigators, a change in 
the composition of the urine. 

The development of the fetus with its membranes and the con- 
tained fluids, along with the increase in the volume of the uterus 
itself, necessarily leads to a corresponding increase in the volume 
of the abdomen. This increase naturally occurs chiefly during 
the later stages of pregnane}', although it begins very early in 
gestation. During these earlier months the apparent increase 
in the volume of the abdomen must be due to an increased 
volume of fat or of intestinal contents, since the actual increase 
in the size of the gravid uterus is not sufficiently conspicuous to 
bring about any visible changes. Later, this change in volume 
becomes more marked and there ensues also some degree of 
change in form, which serves to distinguish the enlargement of 
pregnancy from other abdominal enlargement. 

The pregnant uterus, having a very high specific gravity, 
drops directly upon the abdominal floor and bears it down, which 
causes the abdomen to enlarge chiefly in the lower part, while 
the upper portion apparently sinks somewhat. 

While this symptom is important as an indication of pregnancy, 
it is not reliable. The enlargement is frequently not prominent, 
so that in some cases, especially in mares, there may be so little 
increase in the size of the abdomen as to wholly deceive the 
owner until near the time of parturition. 

On the other hand, various diseased conditions may give rise 
to an enlargement of the abdomen which may closely simulate 
pregnancy, such as dropsy or tumors of the ovaries, uterine 
tumors, hydrometra or p5'ometra, ascites, and dropsy of the 
kidney (hydronephrosis) and other abdominal organs. Even 
in health, some females, especially the large herbivora, acquire 
a very voluminous abdomen from feeding heavily on hay or 
grass, and the condition at times so closely simulates pregnane}^ 



388 Veterinary Obstetrics 

as to lead to error. The enlargement of the abdomen, as a sign 
of pregnancy, becomes valuable, therefore, only in connection 
with other signs and should not be depended upon alone. 

The enlargement of the mammse normally begins quite early 
during pregnancy in primipara, while, in animals which have 
produced young several times, these organs do not ordinarily 
show signs of enlargement until toward the close of gestation. 
In the cow or goat which is used for dairying purposes, the 
milk flow may be perpetual and, when the milking of the animal 
has been continued throughout gestation, there is no notable en- 
largement of the udder. In poor milkers there is usually a 
tendency for the flow of milk to decrease soon after impregnation 
and in many cases it is impossible to keep the cow milking up 
to the time of parturition or even to mid-term. In other cases, 
however, the animal continues to secrete milk throughout gesta- 
tion, and toward the time of parturition, when the mammse 
would ordinarily enlarge as a result of pregnancy, there is in- 
creased secretion of milk. 

The enlargement of the mammae is not, however, a trust- 
worthy sign of pregnanc3^ In some animals the glands fail to 
enlarge to any appreciable degree and, after parturition, fail to. 
furnish milk for the nutrition of the young. This is especially 
observed in old mares, which have been bred for the first time. 
On the other hand, the mammae become enlarged in the absence 
of impregnation. Fleming states that the milk glands may be 
aroused to activity in the young animal, when but a few days 
old, owing to suction upon the teats, as is habitually observed 
in 3'oung calves when a number of them are kept together, in 
which case they form the habit of sucking each other repeatedly. 
While this rarely excites the glands to function, it is claimed 
that it does at times. In other cases it is repeatedly noted that 
animals which are in estrum show functional activity of the milk 
glands. -The bitch, while in estrum, very frequently shows en- 
largement and some functional activity of the mammas. We 
have observed a mare mule which, though presumably incapable 
of impregnation, constantly soiled her hind legs badly while in 
estrum, owing to a profuse flow of milk from the greatly en- 
larged udder. 

It has been claimed that toward the close of gestation there 



Signs of Pregnancy 389 

are alterations in the composition of the urine of the pregnant 
animal, consisting chiefly in a decrease in the salts of lime, but 
the data upon this point are not sufficient to warrant any definite 
conclusion. 

Some have proposed to weigh animals suspected of being 
pregnant, but the weight of animals varies so greatly, as a result 
of the character of food, work or health, that no deductions can 
safely be drawn in this way. 

Finally, when parturition is near, there is an increased vascu- 
larity of the mucous membrane of the vulvar opening. 

In the cow, a further sign of pregnancy, applying only near the 
close of gestation, is that of sinking of the hips owing to relax- 
ation of the broad sacro-scig.tic ligaments of the pelvis. As al- 
ready noted similar signs are regularly observed in sterility es- 
pecially when due to diseased ovaries. 

None of the foregoing signs of pregnancy are wholly reliable. 
While they generally answer the purposes of the breeder, there 
are frequent exceptions which may lead to more or less serious 
error. Any one of the foregoing symptoms of pregnancy may 
be induced by other causes and any one of them may be absent 
nearly or quite to the time of parturition. 

Positive or Direct Signs. 

We can only determine the existence of pregnancy positivelj^ 
by observing the presence of the fetus in the uterus by some un- 
equivocal means. To this end we have definite means : i , by 
vaginal, rectal or abdominal manipulations or by ballottement ; 
2, by auscultation of the fetal heart-beat ; 3, by observing the 
movements of the living fetus. 

The determination of the presence of the fetus in the uterus 
by manual exploration is more or less available in all our domestic 
animals when gestation is well advanced. In our larger her- 
bivora it is not easy to feel the fetus through the abdominal 
walls, because of their tension and firmness, but in the small 
animals, like the bitch and cat, the fetuses may be somewhat 
easily felt through the thin abdominal walls. 

In the larger animals, if the fetus is well back and a portion 
of it projects into the pelvis, it may readily be touched and re- 
cognized through the vagina. This method, however, is not so 



390 Veterinary Obstetrics 

available as that per rectum and is quite inapplicable, as a rule, 
until very near the close of pregnancy. 

In the mare and cow, rectal exploration affords conclusive 
evidence of the presence of a fetus. If the rectum is properly 
emptied and the oiled hand is introduced to the full length of 
the arm, it is generally possible to reach the fetus as it lies within 
the uterus and, by careful palpation, to distinguish its parts. 
Usually in the course of this palpation, after the mid-term of 
pregnancy, the fetus reacts to the touch and moves somewhat, 
revealing not only its presence, but also the fact that it is living. 

In some cases, however, when the fetus has acquired con- 
siderable volume and the abdomen of the mother is quite 
capacious and pendulous, the fetus drops so far away forward 
that it may be almost out of the examiner's reach. In such 
cases the examiner will find the enlarged tightly stretched 
vagina passing over the brim of the pelvis and disappearing 
forward into the abdominal cavity. This is in marked contrast 
to the normal non-gravid uterus, which can be readily dis- 
tinguished and picked up by the hand per rectum. When the 
uterus has thus disappeared out of i'each forward, the ovaries 
have also been dragged with it and cannot be touched. This 
absence of the uterus from its normal non-gravid position and 
the presence of the enlarged and stretched vagina extending 
forward, is at least conclusive evidence that the uterus has been 
borne forward by a load of some character, which we would at 
once assume to be a fetus. Further manipulation will reveal the 
presence of the fetus, some part of it lying within reach. 

In making the examination per vagina or per rectum, great 
care should be taken to provoke as little excitement of the 
animal or irritation of the uterus as is possible. It is needless to 
suggest that the examination per vaginam should be made under 
antiseptic precautions and in a manner which would not cause 
straining. The examination should be made through the walls 
of the vagina at the sides of the cervix ideri and not through 
the OS uteri, as this would inevitably jeopardize the life of the 
fetus. 

Ballottement may be carried out in two ways. Some claim 
that ballottement can be practiced in small animals, the same as in 
human obstetrics, per vaginam : but it would seem that the re- 



Sig7is of Pregnancy 391 

suits are not satisfactory because, in our multiparous animals, 
the fetuses lie in the cornua and, even though we place the 
animal in a vertical position, the young cannot readily drop into 
the pelvic cavity in a manner to permit of ballottement. 

In the larger domestic animals, ballottement through the ab- 
dominal walls is usually quite satisfactory, after some experience 
has been acquired. The animal is examined in the standing posi- 
tion. The veterinarian stands upon the right side of the cow, 
or upon either side of the mare, though preferably upon the left, 
and places the palm of his hand against the abdominal wall in 
the lower flank region just above and anterior to the udder. By 
a sudden push upward there should be recognized a hard body 
which recedes from the hand as though floating in a liquid and, 
a moment later, falls back again and strikes the examiner's hand. 
The exact point for this manipulation must be determined for 
each individual case and it may be necessary to search the sur- 
rounding area for some distance before coming in contact with 
the fetus and thus recognizing its presence. This constitutes 
one of the most reliable and available methods for the diag- 
nosis of pregnancy. There are no other normal abdominal con- 
tents which can thus be pushed away from the abdominal wall 
with a bound and then fall back again with an evident impact 
upon the point from which they departed. Naturally, this meth- 
od is only applicable after the • fetus has acquired considerable 
volume ; hence, it is not available for purposes of diagnosis until 
the beginning of the last half, or third, of pregnancy. 

The determination of pregnancy by auscultation of the fetal 
heart-beat is recognized as positive in its results. It is only 
available when the fetal heart has acquired such dimensions and 
force as to render its sounds audible. It not only demonstrates 
fully the presence of a fetus, but also gives the important infor- 
mation that the fetus is alive. 

The heart-beat of the young consists of regular sounds which 
are not rythmic with the beat of the maternal heart ; they are 
much more rapid and have a different character, the sound hav- 
ing less volume and being somewhat clearer — perhaps we should 
say having a higher pitch. L,afosse claims to be able to diag- 
nose pregnancy in the cow at six months by the heart sounds, 
but admits that the results are not uniform in all cases, or rather. 



392 Veterinary Obstetrics 

that in some the heart-beat cannot be perceived, but that, when 
present, it is thoroughly reliable. As a general rule, the rate of 
the heart-beat is about twice that of the mother. The heart- 
beat is detected best in the standing animal along the floor of the 
abdomen or low down in the flank, though the exact point for 
'iDest hearing it must be determined separately for each case. In 
our experience we have found it very easy in most cases to de- 
tect the heart-beat in the mare, cow and ewe, either directly or 
with the aid of the stethoscope. 

Under some conditions, when the intestines are very active, 
their sounds may mask or obliterate those of the heart, render- 
ing the examination verj' difficult and possibly destroying its 
efficiency. 

The movements of the fetus constitute clear evidence of preg- 
nancy and of the fact that it is alive. We have no reliable and 
safe methods for inducing movements of the young and, con- 
sequently, this evidence of motion is procurable only by chance 
or at considerable risk. Fleming remarks that some ignorant 
persons pour water into the ears of the pregnant animal, in order 
to cause it to make violent efforts to get rid of the fluid, and 
claim that, if the animal is pregnant, it will only shake the head 
and ears. Others give a drink of cold water to an animal which 
is warm and very thirsty and thus induce movements of the fetus, 
owing to the shock from the close proximity of the cold water 
when it enters the stomach or rumen, to the fetus. This is a 
dangerous procedure, liable at all times to cause abortion. 

The only safe method of determining pregnane^' by the 
presence of fetal movements is by long and repeated observations, 
until the fetus makes more or less distinct movements, in a volun- 
tary way, which can be seen through the abdominal walls. 
These occur in most, if not all, pregnant animals, but are most 
readil3' observable in the mare and cow, where the size and 
strength of the fetus suffice to bring about very vigorous move- 
ments. They are noted chiefly at the same point in the abdomen 
as that designated for ballottement, that is, in the lower flank 
region. 

In all these methods for diagnosing pregnancy, it will be ob- 
served that none of them are applicable or reliable in the earlier 
stages, so that at this period reliance must be placed upon the 



Sig7is of Preg7ia7icy 393 

two preceding classes of symptoms rather than upoii direct in- 
vestigation. Among these direct methods, that most early 
available is the manipulation per rectum, which can be made to 
succeed as earl}^ as a fetus has acquired sufficient size to be felt 
floating within the uterus. In this case, upon examination per 
rectum, the uterus is found markedly enlarged and softened and 
more or less fluctuating or sugillating. Floating somewhere 
within the liquid, usually lying at the bottom on account of its 
high specific gravity, is the fetus, which is perfectly movable 
and some of the parts of which may be recognized. 

The differentiation of pregnancy from various diseases of 
the uterus or abdominal organs sometimes causes difficulty. 

The uterus itself is subject to a variety of diseases which cause 
its enlargement and thereby simulate the pregnant condition. 
In very rare cases there has been observed, especially in the 
cow, a dropsical condition of the uterine walls, which causes the 
organ to become enormously enlarged and leads sometimes to 
the supposition that the animal is pregnant. In such cases, our 
only positive means for differentiation is the determination of the 
presence or absence of the fetus itself within the uterine cavity, 
by one or several of the methods which we have already described. 
Such a uterus will not respond to ballottement, there can be no 
fetal heart-beat and no fetus can be touched by rectal explora- 
tion. 

Extensive abscess of the uterus, or pyometra, might be mis- 
taken for pregnancy. In the case of pyometra, there is usually 
some abnormality of the cervix uteri and a more or less constant 
discharge from the vulva, while the uterus itself is very flaccid 
and the two horns are usually distended alike, no fetus being 
recognizable in either. In abscess of the uterus, the organ is 
large and more or less spherical and its walls are hard and tensely 
stretched, while an examination through the vagina shows that 
the OS uteri is obstructed or effaced. 

Uterine tumors may be mistaken for a fetus, but should be 
distinguishable by the fact that they do not move in the uterus, 
but only with the uterus or its walls ; that is, the tumor may be 
pushed back and forth only to the same degree as the uterus it- 
self moves with it, while the fetus may move freely within the 
cavity of the organ, except in cases of mummification. 



394 Veterinary Obstetrics 

Tumors of the ovaries, whether cystic or solid, rarely attain 
sufficient size to be mistaken for pregnancy, though in one 
case we observed in a sow an ovarian tumor weighing 28 
pounds. These tumors are to be differentiated from pregnancy, 
or at least from normal uterine pregnancy, by the fact that the 
uterus itself is normal, empty and in its proper location, except 
as it may be displaced by the weight of the tumor. 

Hydronephrosis, or cystic kicfney, is occasionally observed in 
our domestic animals, usually in the sow, and may simulate 
pregnancy to the extent of causing a very great increase in the 
size of the abdomen. In one case which we observed in a sow 
which would normally weigh about 300 pounds, there was a 
cyst of the kidney which occupied almost the entire abdominal 
cavity and caused a very great enlargement of it. The weight 
of the cyst finally became so great that the animal could not 
rise when down. The cyst contained about 80 pounds of fluid. 
In an animal of this size, it is not easy, for a time, to differentiate 
between this condition and pregnancy. In the cystic kidney, 
however, the cyst augments continually and more or less rapidly, 
giving the body a general fullness, which is not at all confined 
to the lower flank region, as in pregrfincy. The abdomen be- 
comes very tense and, moreover, there is likely to be increased 
thirst, along with some depression and greater difficulty in mov- 
ing than if the animal were pregnant. Moreover, there is 
usually some history of the date of breeding and the enlargement 
of the abdomen soon shows a want of harmony between it and 
the period of possible impregnation. If the normal duration of 
pregnancy has been exceeded and the distension is very great, 
these facts become highly diagnostic ; or, if great distension of 
the abdomen occurs prior to the time at which pregnancy 
should normally cause enlargement, it becomes obvious that 
this is due to some other cause. 

Ascites, or dropsy of the abdomen, may also become confused 
with pregnancy, especially in the bitch, where it is comparatively 
common. Here again our differentiation would depend largely 
upon the same considerations as in cystic kidney, between which 
two conditions there is little difference in the symptoms in the 
living animal. 



Duration of Pregnancy 395 

In either hydronephrosis or ascites, along with general 
symptoms of those maladies, the trocar may be used as an aid in 
diagnosis. 

The Duration of Pregnancy. 

The duration of pregnancy varies greatly according to the 
species of animal, in the individuals of the same species and even 
in the same individual during different pregnancies. In our 
domestic animals we find the extremes of variations in normal 
duration in the rabbit, where the young are carried for 28 to 30 
days, and in the elephant, where the duration is i ^ years, or 
about 21 months. The duration of pregnancy is not definite in 
the individuals of any species and the limits in variation increase 
somewhat according to the increase in the average duration. 
In those animals h"aving a short period of gestation, like the 
rabbit, the variation is very slight, scarcely exceeding two days, 
while in the mare, with an average duration of a trifle more 
than II months, the variability is increased to two or three 
months. The variations in the duration of normal pregnancy in 
the mare are more than twice the normal duration of pregnancy 
in the rabbit. 

The duration of pregnancy bears a somewhat inconstant ratio 
to the size of the animal and, as a general rule, the larger the 
animal, the greater the duration of pregnancy. This law, how- 
ever, is not wholly applicable and in some cases would seem to be 
well-nigh overthrown. In a given species where there are great 
variations in size, as in the dog, there is no variation in the 
duration of pregnancy because of size, so that the great Mastiff, 
weighing more than 100 pounds, has no greater gestation period 
than the Toy Terrier weighing 2 or 3 pounds. In some cases, 
also, species which are somewhat closely allied have very uniform 
periods of pregnancy, which do not accord with the differences in 
size. Thus, the duration of gestation in the dog is only a trifle 
greater (about 12%) than in the cat. In those species which 
cross to produce hybrids, such as the horse and ass, the duration 
of pregnancj' is naturally nearly the same. 

The duration of pregnancy is also somewhat dependent upon 
the state of development in which the young are, born. Thus, 
in the carnivora we find a duration of 8 or 9 weeks, while in 



396 Veterinary Obstetrics 

sheep and swine, which are but little larger in many instances, 
the duration is more than double. However, in these latter 
instances, when the young are born they are far more developed 
than the former. 

It has been claimed that breed exerts some influence upon the 
duration of pregnancy and Wilhelms has asserted that the 
Hungarian cow goes some 10 days longer than the Dutch cow. 
Fleming is of the opinion that thoroughbred mares have a longer 
duration of pregnancy than those of the common breeds. 

Statistics apparently show, also, that a male fetus is carried a 
trifle longer than a female in those animals where generally but 
a single young is born at a time, but if any difference exists it 
is quite unimportant obstetrically. 

It may be that some of the variation in the duration of preg- 
nancy can be accounted for by the time during estrum at which 
copulation takes place or the time elapsing between copulation 
and fertilization. This can scarcely apply to any great extent 
in such an animal as the cow, in which the estrual period is 
ordinarily less than 24 hours, while the variation in the duration 
of pregnancy is very great, and in which fertilization does not 
follow forced coition at or subsequent to the close of estrum. It 
has not been determined how long a time is required for fertiliza- 
tion to take place after impregnation, but it may generally be 
assumed that the ovulation occurs soon after copulation and that 
fertilization follows promptly. 

According to Bonnet, the ova of the ewe, sow and bitch have 
undergone segmentation and passed through the oviducts to the 
uterus eight to ten days after coition, which would intimate that 
the fertilization had occurred within a few hours after ovulation 
and impregnation, and segmentation had promptly begun. Thus, 
the time elapsing between coition and fertilization must be in- 
consequential, as related to the span of gestation. 

The chief cause of variation in the span of gestation does not 
rest upon these considerations. To some extent it may be ex- 
plained b3' the fact that the fetus may be expelled in a state of 
relative immaturity, almost a premature birth ; it may reach 
that average stage of development which we would designate 
as normal, or it may remain more or less quiescent in the uterus 
for a period after the attainment of this normal degree of intra- 



Duration of Pregnancy 397 

uterine development. It is reasonable also to conclude that the 
rate of development of the young will vary according to the in- 
dividual character of the mother and may be dependent, in a 
degree, upon her state of nutrition. 

Duration of Pregnancy in the Mare. As a general rule, 
the duration of pregnancy in the mare is about 12 lunar, or a 
trifle over 11 calendar months, or about 330 to 340 days. Bon- 
net gives iij4 to 12 lunar months (322-336 days) as the 
normal. Dietrichs, among 500 observations, found that 80% of 
mares foaled between 331 and 350 days. Count Lehndorff, 
in his text-book on horse breeding, gives a table of more than 
8,300 records, in which the average duration of pregnancy was 
1 1 months and 3 days. Statistics show that, in various studs, 
the male foals were carried from y^, to 6 or 8 days longer than 
the female. There are great variations of opinion bj^ different 
writers in reference to the normal duration of pregnancy. Some 
consider normal a birth which occurs anywhere from 300 days, 
or 10 calendar months, to 365 or more days and some even ex- 
tend the limit to 394 or even to 420 days, as in a case given by 
Baumeister and Rueff. 

Saint-Cyr concludes that the normal duration of gestation in 
the mare is 340 to 350 days, between which time most foals are 
born. Some may be born alive and continue to live, from the 
300th day onward, while it is not rare for foals to be born up to 
nearly 365 days. Rarely normal gestation may be prolonged to 
400 days or over 13 months. It would seem, therefore, that 
there may be a variation, in the period of gestation in the mare, 
of about 100 days, or more than three months, and that we ap- 
parently have no means for determining in advance at what time 
a mare will foal, except that, in a general way, we may expect 
the vast majority of births to take place between 11 and 11^ 
calendar months. It has been alleged that breed has a certain 
degree of influence upon the span of pregnancy and statistics of 
Count Lehndorff seem to indicate that, in different studs, there 
are more or less marked differences in the duration. 

A former client, engaged in breeding pedigreed French draft 
horses, found that, in 55 mares, the average duration of preg- 
nancy was 336 days. Among the 13 pregnancies in one year, 
the average was 333 days, the longest being 364 days, a 



398 Veterinary Obstetrics 

mare foal, and the shortest 318 days, a horse foal. The shortest 
duration recorded by him was 298 days, the foal being a mare. 

Duration of Pregnancy in the Ass. 

Carsten-Harms gives the duration of pregnancy in the she-ass 
as 348 to 377 days, which is in excess of the average duration in 
the mare, but the observations which have been made are not 
sufficient in number to render them very reliable. Various 
writers claim that the period of gestation of mule foals is 
greater than with horse foals. 

The Cow. The duration of gestation in the cow is usually 
270 to 280 days, with a very wide variation. In 1062 cases 
quoted by Fleming, 15 were pregnant less than 241 days, 52 from 
241 to 270 days, 119 from 271 to 280 days, 544 from 271 to 300 
daj's, 230 from 282 to 290 days, 70 from 290 to 300 days, and 32 
beyond 301 days. Fleming gives the average duration at about 
283 days, while Colin makes the average 280 to 285 days. 

The Sheep and Goat. The duration of pregnancy in the 
sheep and goat is about 5 months, with variations of some 12 
days. Some observers have found that the duration of gestation 
was longer in female than in male lambs and there is an impres- 
sion, which is apparently supported by statistics, that twins are 
born somewhat earlier than single fetuses, but the difference, if 
any exists, is very slight. 

The Sow. The duration of pregnancy in the sow is a trifle 
short of four calendar months, or about 115 to 120 days, the 
variation not being very great, although some authors give, as 
extremes, about 104 to 127 days, with most births occurring be- 
tween 115 and 125 days. 

Carnivora. The bitch is pregnant from 58 to 65 days, but 
usually about 9 weeks or 63 days, while the duration of preg- 
nancy in the cat is 3 or 4 days less, or about 8 weeks, with a 
variation of 3 or 4 days. 

Wild Animals. 

In wild ruminants, the duration of pregnancy varies from 34 
or 35 to 40 weeks. Harms notes the peculiar fact that in the 
deer there is a period of 40 weeks between impregnation and the 
birth of the young, but that this time does not represent the 
period of development of the fetus as we understand it in most 



Twin Pregnancy 399 

animals. The ovum of the deer undergoes segmentation and 
then lies in the uterus for four months in an essentially dormant 
state. About December the distinctive embryonic development 
begins and birth follows in May or June, or about five months 
later. If this time of five months, during which the active de- 
velopment of the fetus has taken place, is compared with the 
duration of gestation in the sheep, the two periods of gestation 
become virtually identical. It is suggested that this delay in 
the development of the young is a provision by which it 
may be born at a favorable season of the 3'ear. 

The Numbkr of Fetuses. 
In the domestic animals we find great variation in the number 
of fetuses ordinarily brought forth at a given birth, and we 
recognize, as a rule, two or three classes of animals in reference 
to these numbers : the uniparous animals, chiefly the mare and 
cow, which ordinarily give birth to but a single young at a time ; 
the biparous, or twin-bearing, animals, among which we find 
chieflj' the goat and the larger breeds of sheep ; and the multi- 
parous animals, among which we include the carnivora and 
the sow. 

Twin Pregnancy. 

In all animals, however, there are occasional departures from 
the rule. Thus, in unipara, we occasionally find twins and 
sometimes, in our multipara, only one or two young are born at a 
time. 

Among our uniparous domestic animals, twins are most rare 
in the mare, although every veterinarian of experience in a 
horse-breeding district has observed such cases. Among cows, 
twins are not at all rare. 

The causes of twin pregnancy may vary. Fundamentally, the 
number of fetuses must depend upon the number of ova which 
have been discharged into the uterus during a given estrual 
period. In some cases, two or more eggs are formed in one 
Graafian follicle and, when discharged and fertilized, may each 
develop into a fetus, but one yellow body remaining in the ovary 
to indicate their origin. 

Usually twins proceed from the simultaneous rupture of two 
ripe ovisacs, with the discharge and subsequent fertilization of 
one ovum from each. 



400 Veterinary Obstetrics 

In other cases, twin pregnancy may be caused by complete 
division of the ovum or blastoderm to form two separate embryos, 
in which instance they become identical twins, being of like sex 
and enclosed in a common chorion each having a separate* 
amnion. 

Twin pregnancy in the mare nearly always results in abortion 
at about the eighth to tenth month and in a large proportion of 
cases it is found, when the two fetuses are expelled, that one is 
much more developed than the other, indicating that the least 
developed one has been dead in the uterus for a considerable 
period of time, without having undergone decomposition. In 
the mare, this twin abortion occurs in probably 90% of the cases 
and, among those which are born alive, it not infrequently 
occurs that one of the pair is liliputian in size. 

Rueff records one case of twin gestation in the mare in each 
25o»cases and this seems to be somewhat near to the average. 
While we have personally observed several instances where both 
twins have been born alive, they are usually more or less im- 
perfect and tend to perish soon after birth. In other cases, 
however, we have seen them quite normal and vigorous, very 
much alike in size and form and partaking of that striking 
likeness common in the twins of other animals and of man. 
Triplets and quadruplets have also been recorded very rarely 
in the mare. As in twins, abortion usually brings the preg- 
nancy to a premature close or, if born alive, the foals are 
generally weak and tend to perish. Saint-Cyr cites one case in 
which a mare, from a single stallion service, aborted two fetuses 
in one chorion and, some months later, gave birth to a living 
and vigorous foal. 

The most interesting cases of twin pregnancy recorded are 
those of a series quoted by Saint-Cyr, in which the twins were 
due to successive copulations. The mare, having been put 
first to a stallion and then to a male ass, brought forth a 
foal and a mule at the same time. In these cases the two copula- 
tions were not very widely separated, usually during the same 
day or, in one case, after an interval of 15 days, probably one 
prolonged estrum. 

In the cow, twin and triplet pregnancies are not so uncommon 
and the tendency to twin abortion, which is seen in the mare. 



Twin Preg?ta7icy 40.1 

is absent. They tend to carry the twin fetuses to the regular 
period as though but one were present, though, as already noted, 
it is claimed that the duration of twin pregnancy is normally a 
trifle less than that'of single pregnancy. 

In some cases there is an hereditary tendency to the production 
of twins in a given strain or family and certain individual cows 
produce twins year after year. Fleming quotes one case in 
which a cow, during an interval of seven years, produced 25 
calves, or an average of more than three per annum, having 
given birth to a single calf the first time and thereafter pro- 
ducing anywhere from two to six calves at a birth. In the one 
instance of six j-oung, all died prematurely. One of the most 
notable cases of excessive numbers is that given in the Magazine 
of Gurlt and Hertwig, Vol. 23, page 125. A cow which had 
given birth to one vigorous calf was butchered, and fifteen 
fetuses were found in the uterus. Other instances of from three 
to six or more calves at a birth are recorded, scattered through- 
out veterinary literature, and are of little interest, except from 
the standpoint of curiosity, unless we should remark that, when 
a cow is attended during parturition, a search of the uterus 
should always be made, after the removal of one fetus, to de 
termine the presence or absence of additional young. 

In the ewe, twins are very common and, in some of the large 
mutton breeds, twin pregnancy becomes the rule and single 
births the exception, aside from yearling ewes. In some well- 
fed bands of ewes, we have seen an average of two lambs per ewe 
for the entire number. In one case of 26 Cotswold ewes we ob- 
served 52 lambs, there having been a sufficient number of trip- 
lets to bring the average up to two lambs per ewe. 

In the smaller breeds of sheep, like the Merino, twins are less 
frequent. 

In the goat, the general rule is twins or triplets. 

We have already noted, page 156, the frequent occurrence in 
the cow of what is known as freemartins, or of twin pregnancy, 
in which one of the pair of twins has become arrested in its sexual 
development and remains to some extent hermaphroditic, or 
neutral, in character. 

The Diagnosis of Multiple Pregnancy in uniparous ani- 
mals is seldom called for except in cases of difficult labor. Even 
26 



402 Veterinary Obstetrics 

then, as a rule, it is not suspected except in those cases where 
the difficult labor is produced by simultaneous presentation of 
parts of the two fetuses. Sometimes a twin pregnancy may be 
suspected on account of the very great size of the abdomen, and 
it might be diagnosed by an exploration per rectum, though not 
with great certainty. When two young present simultaneously 
at the pelvic inlet and cause d5?stokia, the condition can usually 
be readily diagnosed by tracing the presenting parts, limbs or 
head, to the separate bodies of the fetuses. The only dif&culty 
occurring, as a rule, is when a single fetus undergoes that de- 
formity which we know as campylorrhachis or schistocormus re- 
flexus, Figs. 71 and 72, in which case the spine of the fetus 
is abruptly bent upon itself, so that the head and all four feet 
present simultaneously at the pelvic inlet, thus closely simulat- 
ing twins. This abnormality is to be differentiated from twins 
by the fact that, when one portion is repelled or advanced, the 
other part moves in harmony with it, which is not true of cases 
of twin pregnancy, where the one fetus can be repelled while the 
other advances. 

Position of Fetuses in Multiple Pregnancy. In animals 
which are normally uniparous, as the mare and cow, it is inter- 
esting to study the position of fetuses in case of twins or triplets. 
In general.it may be stated that, where twins occur as a result of 
the .simultaneous rupture of two ovisacs and the fertilization of 
the eggs, they develop two complete sets of membranes, each 
fetus having its own amnion and chorion. In those cases where 
twin pregnancy is due to the fission of a single ovum, the two 
embryos are developed in the same chorion, but each has its own 
amnion. 

When the two fetuses each have separate membranes, it is pos- 
sible for one of them to be expelled at one time and the other to 
remain in the uterus for a considerable period afterward and 
finally be born alive. In this way we find recorded, in our liter- 
ature, occasional instances where an animal has aborted one fetus 
at a comparatively early period in gestation and later, after the 
normal duration of pregnancy, has given birth to a living twin. 
We find quite commonly, in the mare, that one of a pair of twins 
perishes and remains in the uterus for a considerable time, while 
the other continues to live and develop. Finally they are aborted, 



Twin Preg7iancy 403 

or the one is born alive, and there is observed a great variation 
in the degree of development of the two, which sometimes leads 
to the belief that thej' represent impregnations at widely sep- 
separated times. 

When death of one fetus occurs early, it may undergo mummi- 
fication and remain in the uterus as an inert bodj^ In our 
museum, there are, in the uterus of a cow, twin mummified 
fetuses which had perished at about the 7th month of gestation. 

In the cow and ewe, each of the twin fetuses very largely 
occupies one uterine cornu and usually presents with the 
head toward the os uteri, but it is not rare to find them 
presenting alternately, that is, one anteriorly and the other 
posteriorly. 

It is interesting to note also that occasionally, in twin preg- 
nancies, one twin is more or less enclosed within the body of the 
other. This presumably results from fis.sion of an ovum, by 
which two embryos result from a single egg and, being unequal 
in size and remaining intimately connected, the one grows 
around and includes the other, until finally its inclusion is more 
or less complete. 



THE HYGIENE OF PREGNANT ANIMALS. 

lyittle can be said, in reference to the hygiene of a pregnant 
female, which would not equally apply to the same species of 
animal in an unimpregnated state. It has been held by many 
that the pregnant female requires different care from others, but 
there is no scientific reason why this should be so, nor have we 
any clinical experience supporting such a contention. 

There is but one view-point from which we may claim that 
special care is essential for the well-being of the pregnant female 
and the young within her uterus. The weight of the fetus 
tends to render the animal somewhat less capable of performing 
certain kinds of labor or movements and the attachments of the 
fetus with the uterus are such that anj' very violent movements 
may cause some disturbance of these. It consequently follows 
that, in animals in an advanced state of pregnancy, more care 
should be used in reference to violent exertions. This is seen 
to some extent in all animals, but more especially in our larger 
herbivora, where the single, very large fetus may cause some 
disturbance of the placental attachments should any sudden 
movement of the mother occur. In a general way, however, we 
would not care to submit a non-pregnant animal to such abuse 
as might lead to injury of the pregnant female. 

The well-being of the pregnant female is best conserved by 
the same diet which would maintain the non-pregnant animal in 
the best state of health and, in relation to exercise, the same 
conditions hold true. Those pregnant females which are 
allowed their freedom and, consequently, get normal exercise 
without any serious disturbance are those which most regularly 
pass through the pregnant state without serious inconvenience 
and danger. Next to these we find the safest pregnancy in 
the mare to be that accompanied by regular daily labor of a 
gentle character. 

Any violent movements in an}' pregnant female are, of course, 
to be obviated as far as practicable. It is important that the 
pregnant mare which is worked should not be roughly jostled 
by the pole of a vehicle, because such blows may serve to directly 
injure the fetus or disturb its placental attachments and thus 
imperil its life. Abortion following, the life of the mother may 
404 



Hygiene of Pregnant Animals 405 

also be in danger. Any form of violence which might bring 
about a sudden and severe impact upon the abdominal walls 
should be avoided. 

Mares used for draft work should be carefully guarded against 
violent pulling, because this tends constantly to increase the 
intra-abdominal pressure and thereby to greatly interfere with 
the circulation in the uterus and to disturb the placental attach- 
ments of the fetus. Abortion, following very severe pulling, is 
not rare. We observe precisely the same danger at times when 
the animal is free in the pasture and becomes accidently mired 
in deep mud. 

Pregnant animals which are used for labor may continue at 
quiet work to the end of pregnancy, but, if the labor is of a 
somewhat strenuous character, it is best to omit it at an earlier 
period. A brood mare put to gentle farm work or other labor 
of a similar character may be continued at it without disadvant- 
age and, in many cases, rather with advantage, up to the time of 
parturition. It is not at all rare in agricultural communities to 
have mares stop in the plow and give birth to a foal without any 
accident and in a very prompt and successful way. We have 
personally observed cases where the mare has dropped in the 
harness and has scarcely permitted time for being unharnessed 
before the foal was expelled. Yet, no harm has come from it. 
We have .seen the same occurrence in mares which have been 
used for driving purposes and where parturition came on so 
suddenly that it was impossible to return the mare to the stable 
and she has foaled upon the roadside. We have never observed 
any untoward effect to either the mother or fetus from such an 
occurrence. 

Anything which is liable to cause the gravid uterus to be 
violently thrown about in the abdominal cavity has a constant 
tendency to bring about injury to the placenta or displacements 
of the uterus which may prove more or less serious. It is not 
safe to drive a mare, well advanced in pregnancy, at a rapid 
pace, because of the unavoidable displacements of the uterus 
with its heavy contents. Consequently, rapid trotting, galloping 
and jumping should be avoided as far as practicable. When 
pregnant animals are free in the pasture they usually guard 
against these excesses and move with care, at a comparatively 



4o6 Veterinary Obstetrics 

slow pace, and thus avoid the dangers which may be thrust 
upon them by injudicious handling while at work. 

Much the same results are noted in pregnant animals which 
are shipped in railway cars. The shipment itself is not essentially 
dangerous under proper conditions, but the unsteady movements 
of the car and the fright of the animal cause it to be thrown 
about more or less violently. If these violences can be avoided, 
the dangers from railway travel are reduced to a minimum 
and rendered comparatively unimportant. 

The dangers which we have enumerated are of such a charac- 
ter that we would generally wish to avoid them in the non-preg- 
nant, as well as in the pregnant, animal. The chief difference is 
that the risk is somewhat greater for the pregnant animal than 
for the non-pregnant, largely because it involves the lives of 
both the mother and the young, each dependent upon the other. 

Some writers suggest that the pregnant female should not be 
allowed near the male, but there is no clinical evidence in support 
of such a contention. It is quite true that in exceptional cases 
a pregnant female will show signs of estrum and copulate with 
the male, but it has not been shown that this is extremely seri- 
ous. Instances have been observed where abortion has quickly 
followed copulation, though it has not yet been determined 
whether the coition caused the abortion or the death of the fetus 
caused the appearance of estrum and hence the coition. At best, 
it may be said that injury from this coition during pregnancy is 
very rare. It is to be remembered, however, that pregnant 
females will only rarely copulate, and it is a notable fact that 
those which do so are almost wholly stabled animals and very 
rarely those which are running at large. In this class of stabled 
animals, if they show estrum it is usually accepted as conclusive 
evidence of non-pregnancy, and the animal is bred, incurring 
all the risks possible were the male habitually free with the female. 

Abortion is probably more rare among those animals where the 
male and female are allowed to consort throughout the year than 
in any other class. Upon the ranges, where the bulls consort 
with cows throughout the year, accidental abortion is not known 
to be any more common, nor even so likely to occur as in stabled 
cows, and the same is true in cases where stallions are allowed to 
consort with mares throughout the year. In our smaller domes- 



Hygiene of Pregnant Animals 407 

tic animals, males habitually consort with pregnant females 
throughout their pregnancy, and yet abortion is far more rare in 
these than in the larger animals. The clinical evidence, there- 
fore, would indicate that it is not harmful to pregnant animals 
to permit the male to consort with them regularly. 

Admittedly, however, it is dangerous to allow a male to be 
abruptly turned loose among pregnant females, where he may 
greatly annoy them and possibly cause serious injury. On the 
contrary, when a male is permitted to regularly consort with the 
pregnant females he does not annoy them nor in any way endan- 
ger the well-being of the fetus in the uterus. 

The quality of food to be recommended for a pregnant animal 
does not differ essentially from that for any other. There are 
foods which are not safe for the non-pregnant animal and are 
equally unsafe for the pregnant female. Pregnant herbivorous 
animals are most healthful if allowed to graze in pastures, under 
the most normal conditions possible. It is not highly essential 
that they should be protected from inclement weather any more 
than if they were not pregnant. Rain, snow, cold or heat is no 
more prejudicial to the well-being of a pregnant animal than to 
that of the non-pregnant. 

Some writers have insisted that certain forms of food, notably 
those which have been attacked by rust, fungi or molds, are 
especially dangerous for pregnant animals. This, however, has 
not been demonstrated clinically. It is quite true that abortion 
is more common at times among animals which are fed upon a 
very poor quality of food, but, if we observe other non-pregnant 
animals which are compelled to subsist upon the same diet, we 
find that they suffer in a similar way in all respects save the one 
question of the well-being of the fetus. Both pregnant and non- 
pregnant animals become emaciated and weak or show other 
constitutional disturbances as a result of being compelled to live 
upon such food and occasionally abortion is merely an additional 
symptom of the injudicious feeding. Special emphasis has been 
placed at times upon foods which are affected with smut or ergot 
and they are blamed for producing wide-spread abortion. As a 
general rule, however, the presence of smut or ergot upon fodder 
is seized upon merely as an excuse for the presence of abortion, 
which may generally be properly attributed to other causes. 



4o8 Veteri?iary Obstetrics 

If contagious abortion breaks out in a harem of mares which 
are running upon corn stalks during the autumn or early winter, 
after the corn has been gathered, it is not difficult for the owner 
or veterinarian to find stalks of corn affected by smut and, 
believing that this causes abortion, to make it serve as a scape- 
goat for the infectious disease which is destroying the foal crop. 
At another season of the year, if the mares are grazing upon blue- 
grass and abortion breaks out, the searcher after ergot may find 
a few traces upon the grass and thereby explain the presence of 
the contagious disease. If the mares are grazing upon red 
clover, which admittedly has a tendency to induce tympany and 
other serious diseases in case of overfeeding, the character of the 
food is again drawn upon to explain the presence of the disease. 

In general it should then be stated that the food should be of 
a good quality, just as it should be for a non-pregnant animal, 
and that in amount it should correspond very closely with the 
volume allowed to ordinary animals. 

In reference to water for pregnant females, there is again no 
essential danger which does not equally apply to the non-preg- 
nant animal. Fleming holds that pregnant aniinals should not 
be allowed to drink very cold water, which is not clinically true. 
We have habitually observed animals drinking cold water at will 
and have never observed any ill effects from it. Throughout the 
western parts of the United States, and even in the Mississippi 
Valley, pregnant animals habitually have cold water during the 
winter season. Upon the Great Plains of the United States, 
pregnant animals very largely use snow instead of water and it 
does them no harm ; when they do drink water from a stream it 
is generally barely above the freezing point. Throughout the 
Mississippi Valley it is not at all rare in the winter season to be 
obliged daily to break or cut the ice which covers the water 
which pregnant animals are to drink. 

Nevertheless, there is some force to the remark in reference to 
the allowance of very cold water ; if an animal is allowed to be- 
come extremely thirsty and has been made very warm by fatigu- 
ing labor and is then allowed to drink an inordinate amount of 
ice-cold water, it may have a very deleterious influence upon the 
fetus, since, when the water reaches the stomach or rumen, it 
comes in close contact with the young animal and causes a very 
severe shock. But even this injudicious allowance of water 



Hygiene of Pregnant Animals 409 

would be improper in case of a non-pregnant animal, and in real- 
ity we have no clear clinical evidence that a draft of such cold 
water causes abortion. In those pregnant animals which are 
much out of doors during cold weather and which go to water at 
will, there seems to be no danger whatever from drinking the 
cold water, because it is taken very slowly, as a rule, so that the 
shock is not so great. It is common to note that these animals, 
after drinking of ice-cold water, shiver somewhat in the cold, 
but this does not seem to have any special danger for the life of 
the fetus. 

Some writers also speak very unfavorably of allowing pregnant 
animals to eat frozen food, or herbage which is covered with 
frost. This notion also seems to be quite erroneous. Upon the 
western plains the animals which are left out during the entire 
winter, whether pregnant or not, must habitually paw or dig 
the snow from the scanty herbage in order to procure food and 
consequently eat with the grass a considerable amount of snow, 
which may be at a temperature of as much as — 40° or — 50° F. 
Yet, pregnant animals do not suffer from this cause. In the 
Mississippi Valley, during the earlier periods in the settlement of 
the country, almost all pregnant animals were fed out of doors in 
the winter time and the food had to be taken from the ground, 
which was largely covered with snow and frequently at quite a 
low temperature. Yet, these pregnant animals almost never 
aborted under any conditions whatever. We must admit, how- 
ever, as we have done in reference to the drinking of cold water, 
that some foods may be so damaged by cold as to make them un. 
digestable and injurious, alike for pregnant and non-pregnant 
animals. Succulent foods, like roots, clover or green vege- 
tables, which are normally killed by a moderately low tempera- 
ture, may be so frozen as to be quite injurious. Naturally, they 
should not be allowed to pregnant animals, nor to those which 
are non-pregnant. 

The housing of pregnant animals- should not differ in any ma- 
terial respect from that of the non-pregnant. The same rules as 
to light, air, ventilation and the amount of cubic space per ani- 
mal applies alike to all, whether pregnant or not. A stall that 
is good for a non-pregnant animal is sufficient for a pregnant one. 
It is of course desirable that the stalls for pregnant animals should 



4IO Veterinary Obstetrics 

not slope very greatly, either backward or forward. The same 
rule applies also to the non-pregnant animal, although pregnancy 
intensifies the backward pressure of the abdominal viscera, in 
case the stall slopes very greatly, and may thus thus tend to cause 
prolapse of the vagina. 

When the time for parturition draws near, it is generally ad- 
visable that cows and mares which have been kept in single stalls 
or stanchions should be removed from these and given some de- 
gree of liberty of movement at the time of labor. Most writers 
advise that the mare should be given a roomy box-stall, under 
the belief that she can better foal in such a place. This may be 
generally true, although accidents have occurred because of the 
very fact that the animal was loose in a box- stall. In such a 
stall the mare sometimes lies down with her buttocks immedi- 
ately against the side wall and there is not room for the expul- 
sion of the foal. Instead, the foal is jammed against the side of 
the stall, its expulsion delayed and its life endangered. In other 
cases the mare turns somewhat violently and the head of the pro- 
truding fetus is seriously injured by being pressed against the 
wall. The box-stall in which a mare is to foal should, therefore, 
be ample in size and give every possible opportunity for labor to 
progress without danger of accident from contact with the side 
walls. Some breeders arrange a special stall for foaling mares. 
A false wall is added, beginning at the base, three or four feet 
inwards from the main wall, and sloping upward and outward at 
an angle of 45°, joining the main wall at the height of three or 
four feet. This slanting wall prevents the foaling mare from be- 
coming cast and the protruding foal from being jammed against 
the walls. 

Later, when considering the question of abortion, we shall deal 
with the handling of animals which have aborted or threaten to 
abort in a stable or herd of other pregnant females. 

The pregnant animal, like any other, should be allowed to lead 
a tranquil existence, free from cruel handling and from great 
fear. If pregnant animals, especially in the advanced stages, are 
chased by other animals, such as ewes being annoyed by dogs, it 
is naturally prejudicial to the life of the fetus. It has been sug- 
gested by some that pregnant animals of different species should 
not be allowed in the same field or pasture, but this is only par- 
tially correct and depends rather upon the character of the indi- 



Hygiene of Pregnant Animals 411 

vidual animals than the question of difference in species. We 
have habitually seen pregnant mares, cows, sheep and pigs in the 
same enclosure, without any special danger to either from the 
presence of the other. 

It needs to be noted that at the time of parturition it is unsafe 
to permit hogs in the enclosure where parturition is occurring, 
since, being omnivorous, they may devour the new-born young, 
and, should the parturient animal be exhausted or otherwise un- 
able to defend herself, she too may succumb to the rapacity of 
the hogs. This is especially true in cases of dystocia and still 
more when prolapse of the uterus occurs. Fleming relates a 
case of prolapse of the uterus in a cow in which hogs devoured 
the prolapsed organ but amputated it so well that the animal 
recovered. 

On the other hand, it is a well known fact that some animals 
take it upon themselves to annoy others, and even compromise 
their lives, whenever opportunity offers. This is especially true 
of mules, which sometimes have so meddlesome a disposition 
that they constantly harry any animal which cannot resist them, 
simply as a pastime ; to a less degree, the same applies to colts. 
Again, we sometimes observe that a pregnant mare or cow is 
exceedingly irritable toward her companions and consequently 
it is sometimes unwise to permit a particularly ill-natured preg- 
nant mare to consort with other pregnant mares, because of the 
injuries which she may inflict upon them by kicking or other 
violence. 

Surgical operations and medication sometimes offer dangers to 
the pregnant animal and should consequently be undertaken in- 
telligently. Serious surgical operations which are not urgent 
should be delayed until after parturition, especially if they involve 
the confinement of the pregnant animal. But this caution should 
not carry us too far. Serious operations, with rigid confinement, 
pain, fear, chloroform anaesthesia, loss of blood, subsequent in- 
infection and fever, are repeatedly performed upon pregnant ani- 
mals without untoward results. While suggesting caution, preg- 
nancy should not be regarded as a bar to major operations upon 
pregnant animals. Much will depend, in these cases, upon the 
temperament of the individual animal. In one instance we dis- 
horned a timid Jersey heifer, which was in an advanced stage of 
pregnancy, and abortion promptly followed in a manner which 



4r2 Veterinary Obstetrics 

suggested that it was due to the fright and paiu of the surgical 
operation or possibly to a considerable hemorrhage which fol- 
lowed the removal of the horns. 

Any drug which causes more or less serious poisoning of the 
mother may naturally imperil the life of the fetus. Chief among 
the drugs which have a bad repute in this respect are aloes 
and other drastic purgatives. Whether these act by passing 
through the placenta and gaining access to the fetus itself and 
injuring it, or by causing contractions of the uterus in harmony 
with the peristalsis of the intestines, we do not know. Usually, 
however, other purgatives, such as bland oils and moderate doses 
of eserine and arecoline, may be given without inducing abortion 
and with the same safety as if the animal were not pregnant. 

Consequently, in dealing with pregnant animals, we should 
constantly bear in mind the possibilities of abortion or other in- 
jury to the fetus, and not cause unnecessary interference which 
may imperil the life of the fetus. From a politic standpoint, the 
owner of the animal should always be advised of the possible dan- 
ger to the fetus from medication or surgical operation and in all 
cases the casting and other manipulations connected with disease 
or operation should be as gently and judiciously carried out as is 
possible. 



ANOMALIES IN FECUNDATION AND GESTATION. 

SUPERFECUNDATION. 

Superfecundation is the fertilization of two or more ova, one 
after another, during one estrual period. When two or more ova 
are discharged during a given estrual period, one or more of them 
is fertilized as the result of one copulation, another ovum as the 
result of a subsequent copulation. If the two or more copula- 
tions are made by the same male, the evidence of superfecunda- 
tion is wanting. When two or more males of different types, 
breeds or species copulate with the female and each fertilizes cer- 
tain ova, the evidence of superfecundation becomes marked. The 
phenomenon may occur in any female in which two or more ova 
are discharged during a given e.strum. If all the ova are simul- 
taneously discharged, superfecundation is less probable, except 
the copulations follow each other shortly. 

Superfecundation is most common in the bitch, in which there 
is a prolonged estrum, probably successive ovulations, and very 
commonly repeated copulations with dogs of various breeds. As 
a result, it is not rare to find the young of a given litter showing 
unmistakable evidences of varying male parentage, some of the 
young being evidently of one breed, others of another. 

In such biparous animals as the sheep and goat, such results 
are always possible, but the opportunity for copulation by males 
of different breeds is not usuallj^ offered. 

In the mare, in which twins are rare, there are records of a few 
cases in which a mule and horse foal have been born as twins, 
the result of closel}' succeeding copulations of a stallion and an 
ass. The two services may be separated by several days, not 
exceeding the duration of the estrual period. Lanzillotti-Buo- 
santi records a case where an interval of eight days elapsed be- 
tween the service by the stallion and the ass. 

SUPERF^TATION. 

Superfetation differs from superfecundation in that fecunda- 
tion occurs in an animal already pregnant, due to copulations 
during two separate estrual periods. The phenomenon depends 

413 



414 Veterinary Obstetrics 

upon two conditions. First, the female must depart from the 
physiologic rule that pregnancy inhibits ovulation and estrum. 

How frequently this rule is violated, we do not precisely know. 
In the cow, especially the closely confined dairy cow, estrum 
during pregnancy is by no means rare. Regular estrum may ap- 
pear for two, three or more periods after fecundation, copulation 
occur and, finally, a calf may be normally born from the first 
copulation. We do not know, however, that ovulation occurs in 
these cases. Perhaps it does. But superfetation rarely, if ever, 
follows. 

A second essential condition is an open passage from the os 
uteri externum, through one of the oviducts, to the pavillion of 
the tube, so that the spermatozoa and ovum may meet. In uni- 
para, this passage tends to become occluded early by the pres- 
ence of a fetus in the uterine body and the adhesion of the fetal 
membranes to the entire circumference of the tube. In bicornual 
uteri, in which the fetuses are usually limited, in their location, to 
the cornua, and the uterine body is vacant, the fetuses of the pri- 
mary fertilization may be confined to one of the cornua, an open 
avenue through the entire length of the other cornu exist and 
a second fecundation at a more or less remote period occur. 
De Bruin (Geburtshilfe b. d. Kleineren Haustieren) quoting 
Kroon, relates that a goat was bred September 14, 1897, estrum 
and copulation reccurring on November 5th, or 52 days later. 
On February 13, 1898, 152 days after the first breeding, and at 
the completion of the normal duration of pregnancy, she ex- 
pelled two living and one dead, fully developed young. On 
the following day, when the membranes were expelled, there 
were discovered three more fetuses, perfectly formed, but 
not fully developed. These Kroon regarded as certainly the re- 
sult of the second copulation. 

Tapken, also quoted by De Bruin, observed superfetation in 
sows. In one instance the sow was bred on February 22, 1890, 
and again 17 days later. On June 21, 120 days from first breed- 
ing, she gave birth to 7 live pigs and, 14 days later, to 9 live and 
3 dead pigs. 

The Wandering of Genital Cells. 

Schmaltz (Carsten-Harms) claims that the spermatozoa may 
pass through one of the oviducts, into the peritoneal cavity. 



Extra- Uterine Pregnancy 415 

and cross over to the opposite ovary. It has also been experi- 
mentally shown that, in rare cases, an ovum which has escaped 
from one ovary, but failed to enter the corresponding oviduct, 
may pass across to the other ovary and enter its Fallopian tube. 
An egg which has emanated from one ovary may become fertil- 
ized, pass through the corresponding oviduct and cornu to the 
uterine body and thence upward into the opposite cornu, to be- 
come attached and develop into an embryo. The evidence of 
such occurrence is found in the fact that a fetus sometimes de- 
velops in one uterine cornu, while the yellow body from which 
the ovum evidently emanated is located in the opposite ovary. 

Polyspermia. 
It is believed by some authors that an ovum may be over- 
fertilized, that is, instead of one spermatozoon penetrating an 
ovum, two or more gain admission to it, in which case the devel- 
opment may be abnormal and lead to the formation of some of 
the double or triple monstrosities. 

Extra-Uterine Pregnancy. 

Extra-uterine pregnancy is the existence, for a greater or less 
period of time, of a living ovum outside the uterine cavity, 
within the abdomen. The precise nature of most cases of alleged 
extra-uterine pregnancy in animals has not been definitely 
ascertained and, before arriving at any final conclusion as to their 
nature, the subject needs much investigation. Not infrequently 
fetuses are found outside the uterus in the abdominal cavities 
of animals, but it has not been clearly shown how they attained 
this position. Many records are given of the finding of such 
fetuses in the peritoneal cavity, but their anatomical relations 
are not recorded. 

Several forms of extra- uterine pregnancy occur : 
I. Ovarian pregnancy has been recorded and verified. In 
these cases it appears that the ovisac ruptures, but the ovum does 
not escape from it and spermatozoa, passing up through 
the oviduct and pavilion of the tube, reach the ovum and bring 
about its fertilization. The ovum may then undergo a develop- 
ment analogous to that observed in the uterus, either enclosed 
within the ovary or attached to it by the fetal membranes. The 
records of ovarian pregnancy are exceedingly rare, and as a rule 



4i6 



Veterinary Obstetrics 



there are no symptoms which would lead to a diagnosis of the 
condition during the life of the mother. Ovarian pregnancy is 
liable at any time to cause the sudden death of the mother, owing 
to a rupture of the ovary when the fetus has developed within it 
or a violent detachment of the placenta, by either of which acci- 
dents fatal hemorrhage is highly probable. 

2. Tubal pregnancy is apparently the most common cause of 
extra-uterine gestation and, in all probabilit}', accounts for the 
majority of cases of this character. Tubal gestation is more 
readily understood than other forms. Any defect in the tube, 
which might cause the arrest of the ovum during its passage 
through it, would naturally result in the attachment and devel- 
opment of the embryo at that point. In multiparous animals, if 
one of the earliest ova should become arrested during its descent. 




Fig. 8i. Extra-uterine pregnancy. Swine. Showing 2 fetuses closely 
adherent to each other and intimately invested hy membranes. 

all those on the ovarian side of it would alike become halted in 
their migration. Consequently, a series of tubal embryos might 
be formed, which apparently occurs sometimes in domestic 



Extra- Uterine Pregnancy 417 

animals, especially in the sow, and leads eventually to the exist- 
ence of a group of two or more extra-uterine fetuses, as shown 
in Fig. 81. 

The cause of the arrest in the migration of the ovum may be a 
folding in the tube or disease or injury of the mucous membrane. 
The tendency of tubal pregnancy in animals is for the develop- 
ment to go forward, in a quasi-normal manner, up to that period 
when the volume of the fetus and its membranes becomes so 
great that the tube is no longer capable of accommodating them. 
Then the thin walls of the tube rupture and the fetus or 
fetuses, with part or all the membranes, pass out into the perito- 
neal cavity. This rupture and the d-etachment of the fetal mem- 
branes may cause fatal hemorrhage. If fatal hemorrhage does 
not follow, and the fetal membranes have not been wholly de- 
tached from the maternal placenta in the oviduct, the fetus may 
become attached to or imbedded in the peritoneal surface, and 
continue to develop. If its placental attachments in the oviduct 
have become wholly separated, the fetus necessarily perishes 
at once and may undergo partial dessication and remain in the 
peritoneal cavity without injury or inconvenience to the 
mother throughout her normal span of life. 

In other instances of tubal pregnancy, the developing fetus 
escapes through the pavilion of the tube and thus gains the 
peritoneal cavity. It may retain its attachment, through its 
membranes, with the tube, become adherent to the peritoneal 
walls and continue until the normal duration of pregnancy has 
been completed and the usual size of the fetus is reached, when 
it perishes and probably partially dessicates. 

We do not ordinarily discover tubal pregnancy during the life 
of the mother, but only upon post-mortem examination, usually 
when the animal is slaughtered for food. 

3. Rupture of the gravid uterus may occur at almost any stage 
of pregnancy, and the possibility of such an accident increases as 
the close of the normal period of pregnancy approaches. Rupture 
of the uniparous uterus most readily occurs in its body or the 
gravid cornu, and the adjacent fetus tends to at once drop 
through the rent into the peritoneal cavity. In the biparous 
uterus, the rupture may occur at such a point as to interfere 
with but one twin, unless the twins have a common chorion, 
27 



4i8 Veterinary Obstetrics 

when each must be affected similarly. In a multiparous uterus, 
the rupture may occur at any part of the gravid organ and one, 
two or more adjacent fetuses escape through the opening. 

The accident usually causes fatal shock or hemorrhage of the 
mother. Otherwise, the fetus may at once perish, infection 
of its body and membranes, through the os uteri, follow, leading 
quickly to fatal sepsis of the mother, or abscessation may follow, 
the adherent surrounding tissues constituting the abscess wall 
and the decomposing fetus and membranes, the abscess contents. 
The abscess may rupture externally through the abdominal 
walls or internally into the intestinal tract. 

Escaping these immediate' dangers, should the chorion remain 
partially attached to the placenta, the fetus may continue to live 
up to the normal period of birth or it may perish immediately, 
but, the OS uteri remaining sealed or infection otherwise avoided, 
the fetus remains as an inert body for an indefinite period, to 
constitute a variety of extira-uterine pregnancy. 

4. It is claimed by some writers that a primary abdominal im- 
pregnation may take place — that is, an ovum may drop into the 
peritoneal cavity and there become impregnated by a spermato- 
zoon, which has traversed the uterus, cornu and oviduct and 
escaped, through the pavilion, into the peritoneal cavity. The 
embryo becomes attached to the peritoneal surface and develops 
in a more or less normal way. No unquestioned case of primary 
abdominal pregnancy has yet been seen. The possibility of such 
an occurrence has not been disproven. The cases thus far cited 
to prove the actual occurrence have all been faulty in some par- 
ticular, which serves to throw a doubt upon the correctness of 
the alleged occurrence. 

The course of abdominal pregnancy in animals, so far as has 
been observed and recorded, is that the fetus or fetuses acquire 
a more or less rigid attachment to the abdominal walls or some 
of the viscera, and the fetal membranes closely invest the fetal 
body in such a way as to compress it into the smallest possible 
space. In the cases ordinarily observed, the fetus or fetuses are 
closely enveloped in firm membranes without any intervening 
liquids, so that the covering, which may be regarded as the am- 
nion, is in direct contact with the hair of the fetus and cannot 
readily be stripped away from it. This is well shown in Fig. 81. 

The fetus usually seems to have been normal originally, but 



Extra- Uterine Pregna7icy 419 

to have later undergone a process of dessication and in this state 
remains as an inert body for an indefinite period of time. We 
have few records of how long a fetus may thus remain as an inert 
body in our domestic animals, because, as a rule, it is only dis- 
covered upon slaughter and the time at which it developed has 
not been determined. In woman, where the observations have 
been more accurate, there are cases recorded where an abdominal 
fetus has remained inert and without inconvenience to the mother 
during a period of more than 50 years. 

The degree of dessication in extra-uterine pregnancy is not 
equal to that observed in intra-uterine mummification, as a com- 
parison of Figs. 81 and 86 well show. Extra-uterine fetuses are 
comparatively plump, usually normal in size and development 
and are closely invested by tough, adherent membranes. Intra- 
uterine mummified fetuses are free from membranous attach- 
ments, greatly shrivelled, discolored and gnarled. 

There are few cases, indeed, in which extra-uterine pregnancy 
has caused any known disease or discomfort in animals. Flem- 
ing cites a number of cases in which the fetus has undergone 
putrid decomposition, with the formation of an abscess, which 
has ruptured into the intestines or other viscera or, more fre- 
quently, externally through the abdominal wall. He classes 
these cases as extra-uterine pregnancy, but submits no evidence 
to show that the fetus was not in the uterus until it decomposed 
and finally escaped therefrom as a part of the contents of an ab- 
scess within the uterine cavity. We shall refer further to this 
subject under the heads of "Torsion of the Uterus," "Atresia 
of the Os Uteri," and " Putrid Decompo.sition of the Fetus." 

The diagnosis of extra-uterine pregnancy is difficult in the 
living animal. In carnivora, the fetus may possibly be recog- 
nized, and its location outside the uterus determined, by extra- 
abdominal manipulation. However, this is difficult, as we can- 
not readily trace the non-gravid uterus by this means. Even 
though we can feel a fetus through the abdominal walls, we can 
not be sure that it is not in the uterus. It may be attached 
firmly to the abdominal floor, which would constitute presump- 
tive evidence that it is extra-uterine, but the proof is not final, 
since one of the uterine cornua, with a fetus included, may be 
firmly adherent to the abdominal wall and thus nullify the diag- 
nosis. In our larger domestic animals, an exploration of the 



420 Veterinary Obstetrics 

uterus may show that it contains no fetus and if, through its 
walls or those of the rectum, a fetus can be recognized it becomes 
clear that we are dealing with extra-uterine pregnancy, or at 
least with an extra-uterine fetus. 

Fleming (Text-Book of Veterinary Obstetrics, ist Edition, p. 
159) quotes S. Della-Rovere as having attended a case of extra- 
uterine pregnancy in a cow, in which he removed a living calf 
through an incision in the wall of the vagina. The citation by 
Fleming fails wholly, however, to show that the fetus was not in 
the uterus. No record is made as to the condition of the uterus 
itself and it is almost certain from Fleming's quotation that it 
was not extra-uterine pregnancy at all. 

It is not at all rare to meet with cases of uterine pregnancy 
which closely simulate extra- uterine gestation. We have already 
suggested, on page 383, while considering the position of the 
fetus during gestation, that in some cases in the cow the fetus 
pushes its way up into the pelvis alongside the vagina and can 
be clearly felt there. This position is apparently normal and has 
no danger, seemingly, for the life of either mother or fetus. A still 
more puzzling condition is the bi-cornual or transverse preg- 
nancy of the mare, in which the fetus lies beneath the vaginal 
floor in a transverse position, in such a way as to lead the inex- 
perienced to believe that extra-uterine pregnancy exists. 

In order to definitely recognize and verify extra-uterine preg- 
nancy in the living animal, the following factors are essential : 
first, we must recognize the presence of a fetus ; second, we must 
establish the fact that it is not in the uterus, and we can do this, 
in case of a uniparous animal, only by determining clearly that 
the uterine cavity is vacant. The emptiness of the uterus must 
be verified either by inserting the fingers or hand into the uter- 
ine cavity itself, or by an ample and authentic examination of 
the uterus per rectum. Otherwise, we can clearly determine 
extra-uterine pregnancy only b}' a post-mortem examination. 

The treatment of extra-uterine gestation is rarely necessary. 
If diagnosed, and it seems to threaten the life or health of an 
animal, the removal of the fetus may be considered. In animals 
which are used for meat purposes, the patient should be sent to 
the butcher at the earliest convenience, providing the meat has 
not been injured by decomposition of the fetus or other disease 
induced by its presence. In carnivora, the fetus may be re- 
moved by laparotomy. 



DISEASES OF THE PREGNANT ANIMAL. 

Special diseases of pregnant animals are comparatively rare. 
Most pregnant animals are kept in a reasonably natural state and, 
consequently, do not suffer greatly as a result of gestation. 
Quite naturally pregnancy confers no immunity against the 
ordinary diseases of animals. Nevertheless, we find more or less 
serious diseases during gestation, which are referable to the preg- 
nant state and which require our attention. The tendency to 
disease of pregnant animals is in harmony with the environment, 
the degree of domestication and the care given the animal. 
Those animals which are most closely confined and housed are 
most subject to diseases during the pregnant state ; but this is 
also in harmony with the prevalence of the diseases of non-preg- 
nant animals. 

The influence of gestation upon the course of the ordinary dis- 
eases of animals is not well marked and apparently makes very 
little difference, except that, when a pregnant animal becomes so 
seriousl}' diseased that its life is threatened, the fetus tends, in 
many cases, to perish and become expelled prior to the death of 
the mother. Hence, any serious disease of the pregnant female 
may acquire additional gravity because of the possibility of abor- 
tion, which would complicate the malady. It must be admitted 
that the fetus constitutes a heavy burden upon the maternal 
system and, when serious disease arises, this demand upon the 
nutritive supply of the mother for the maintenance of the life of 
the fetus may constitute a factor in reference to the prognosis of 
the malady. Advanced pregnancy may greatly modify the prog- 
nosis of fractures, strains and other more or less disabling inju- 
ries, the extra weight of the gravid uterus adding to the difficulty 
of getting up and down and interfering with locomotion in a 
manner which may jeopardize the life of the mother or the young. 

All those infectious diseases which are frequently accompanied 
by abortion, such as contagious pleuro-pneumonia of cattle, sheep- 
pox, contagious cellulitis or pink eye, hog cholera, and foot and 
mouth disease, are constantly more dangerous for the pregnant 
female than for other animals, because of the danger which they 
possess for the life of the fetus, and the extra hazard to the 
mother through its death and expulsion. 
421 



422 Veterinary Obstetrics 

Fleming claims that the pregnant animal suffers especially 
from numerous affections which are seen less frequently in the 
non-pregnant, and, according to his view, should be in some cases 
referred to the pregnant condition. Among these he mentions 
the cramps of the muscles of the hind limbs, which simulate 
closely, he says, dislocation of the patella in non-pregnant ani- 
mals, though he does not point out the difference between the 
two affections. Since the actual character of the so-called up- 
ward dislocation of the patella in the horse is in controversy, it is 
not necessary for us to discuss the question of the differential 
diagnosis, but merely to state that the occurrence of this cramp 
is not extremely rare in the mare and that it may readily be over- 
come, as in the so-called dislocation, by causing the animal to 
move the affected limb and then looking after the exercise and 
general care of the patient. 

Other veterinary writers also refer to pica, or morbid appetite 
in pregnant animals, although no evidence is adduced that this 
is any more common in the pregnant than in the non-pregnant 
state, or that gestation has anything whatever to do with its 
occurrence. It requires no special notice in reference to han- 
dling, but should be dealt with as in the non-pregnant animal. 

The same may be said of the question of constipation in preg- 
nant domesticated animals. The annoyance from this trouble 
in pregnant women is well known, but it does not apparently 
hold true in animals to any marked degree. It usually depends 
chiefly upon too close housing and injudicious feeding and 
should be corrected simply by removing the causes and giving 
the animal proper attention. 

Fleming further refers, among the diseases of pregnancy, to 
edema of the feet and limbs of the mare, which he compares to 
that observed in woman. It is a well known fact that edema of 
the feet and limbs is a common malady in the horse, without 
any reference whatever to pregnancy, and it^is only natural that 
in the pregnant state, while the animal is more quiet than usual, 
such an edema may become emphasized. Beginning, as is 
usual, in the lower parts of the limbs or feet, it reveals itself as 
an infiltration of the connective tissue beneath the skin, which 
is painless and tends to pit under pressure. The degree of this 
edema may vary and it may gradually extend upward toward 
the body. 



Osteomalacic 423 

It has little real significance, so far as the well being of the 
mare or foal is concerned, and tends to disappear shortly after 
parturition. It may be largely avoided, during the period of 
pregnancy, by careful attention to the diet and the allowance of 
regular exercise. It is usually not seen in those mares which 
are kept at moderate work regularly, run at pasture, or are other- 
wise kept constantly out of doors where they may take natural 
exercise. This condition should not be confounded with rupture 
of the prepubian tendon or the infiltration of the abdominal floor 
leading thereto. 

OSTEOMALACIE. 

Osteomalacie is described by numerous European writers as a 
common disease of pregnant animals. It does not differ, appar- 
ently, from the osteomalacie of non-pregnant animals but is 
believed to be more common and severe in the pregnant animal. 
Its chief interest to the obstetrist is the greater susceptibility to 
the malady. In some instances, epizootics of osteomalacie have 
been recorded in pregnant cows and other pregnant animals. 

St. Cyr attributes the malady to three chief causes: i. Defi- 
cient quantity and quality of food. 2. The parturient state. 3. 
Prolonged lactation. 

The first, in conjunction with bad housing, is generally in- 
voked to explain the occurrence of osteomalacie in non-pregnant, 
as well as in pregnant animals. The second reason assigned, the 
pregnant state, is generally recognized as a cause of osteomalacie. 
The third cause is presumed to act merely by lowering the vital- 
ity of the animal, and thereby increasing its susceptibility. 

The beginning of the malady is obscure. The pregnant cow 
moves carefully, maintains the recumbent position more than 
usual, and exhibits rheumatic symptoms. The appetite remains 
good and fever is absent. 

Then follow fractures of a more or less spontaneous character ; 
a slight misstep, a slip or even an effort to rise, serves as a 
sufficient cause. The pelvis suffers most frequently and, in 
many cases, is comminuted. Other bones — scapula, sternum and 
long bones — are less commonly broken. 

M. Germain reports the symptoms in the goat as consisting 
primarily of paraplegia, followed by swelling of the jaws and loos- 
ening of the teeth in the alveoli, with difficult mastication. 



424 Veteritiary Obstetrics 

In solipeds, fracture of the vertebral column is not rare. 

The diagnosis of the malady is not easy, as there occur no very 
definite symptoms, except those of general ill-health, until per- 
haps a fracture occurs and this too often is referred to accident. 
When a fracture occurs in a pregnant animal, without sufficient 
known accident, the fact may well arouse suspicion of osteo- 
malacic. 

The prognosis, once the disease is well established, is very 
grave. When the malady becomes enzootic and, as a conse- 
quence, its nature is recognized early, much may be accomplished 
by improved hygiene conditions, especially by a liberal supply of 
nutritious food of proper quality. With these improvements, 
further benefit may be derived from the administration of nux 
vomica and iodide of potash. Some recommend phosphoric acid 
or calcium phosphate, interuall}'. 

Dropsy of the Amnion and Allantois. 
Hydrops Amnii. Hydrallantois. 

When describing the amnion and allantois we alluded to the 
fact that there is regularly present an amount of fluid within 
each of these sacs, which may vary in different individuals of the 
same species, the quantity in the mare and cow being usually 
about 5 to 6 1. of amniotic, and 6 to 15 1. of allantoic fluid. When 
it materially exceeds this amount we have the condition known 
as dropsy of the amnion. This affection occurs in various do- 
mesticated animals. It has been observed chiefly in the cow 
and next in the mare, though Saint-Cyr records one case in the 
goat, and Merrick has observed it in the ewe and bitch. 

Generally the exact nature of the disease has not been fully 
determined and, in the majority of cases which we meet clinically, 
we do not determine whether the fluid is chiefly or wholly within 
the amnion or the allantois. In woman, where the allantois is 
devoid of a cavity from an early date, the drops}^ naturally occurs 
in the amnion. Because of this fact, veterinarians refer generally 
to the malady as hydrops amnii, regardless of the fact that the 
collection may be in either or both sacs. In our domestic ani- 
mals, where the allantoic cavity is quite as extensive as, or larger 
than the amnion, the fluid may be collected in either membrane 
or may pass from the one sac into the other through the urethra. 



Dropsy of the Amnion and Allantois 425 

■bladder and urachus. According to Kammermann, the greater 
amount of the fluid is generally in the allantois, but may be 
found in the amnion. In those cases which are attended during 
the life of the animal and in which the fetus is extracted, we 
naturally obliterate the evidence as to the location of the fluid, 
because it is all evacuated and the membranes are largelj- de- 
stroyed. 

The increase in the amount of fluid varies greatly in different 
■cases. Harms records an accumulation of 8 1. in. the goat, while 
Lindenburg and Georgi record 120 and 150 1. in the cow. In 
the mare, the amount may reach 100-160 1., according to Kam- 
mermann and Georgi. These records, of course, indicate some of 
the more severe cases and, between these and the normal, there 
is every possible gradation. While we have observed several 
instances in the cow, we have not accurately measured the 
amount of fluid in an}' case, but our estimates are in accord with 
the foregoing. 

The symptoms in the cow vary greatly according to the 
severity of the malady and, in many instances, they do not at- 
tract much attention until the disease has acquired an extreme 
degree. There appear some of the general symptoms of ill-health, 
as indicated by a rough and staring coat. The ej'es are sunken 
and there are present the general appearances of dullness, weak- 
ness and anemia. The pulse is weak and frequent and the heart- 
"beat more or less tumultuous. The respiration is labored. The 
movements of the animal are more or less difficult. The cow, in 
many cases, emits a grunt during expiration. The appetite 
finally becomes somewhat decreased and the bowels may be 
slightly constipated, though there is usually nothing very evi- 
dent in this respect. Rumination may be decreased or sus- 
pended. The urine is decreased in quantity. 

According to the acuteness of the malady, thirst is increased, 
since evidently the increased amount of fluid in the amnion or 
allantois must be derived from the liquids which the animal con- 
sumes. It consequently occurs that, in severe cases, there is 
usually very great thirst. 

The abdomen becomes abnormally enlarged, the abdominal 
walls exceedingly tense and percussion gives a dull sound. If 
Ihe animal is caused to move suddenly or the part is given a 



426 Veterinary Obstetrics 

sudden thrust or blow with the hand, there may sometimes be 
recognized a splashing sound. 

Examination per rectum reveals the uterus abnormally dis- 
tended with fluid, constituting a vast, tense, immovable sac,, 
pushing the other viscera aside and filling, more or less com- 
pletely, the entire abdominal cavity. The enlarged state of 
the abdomen frequently leads the owner to suspect twin preg- 
nancy or a fetus of abnormally large size. Since the fetus is of 
higher specific gravity than the surrounding liquid, it may lie 
so low down along the floor of the abdomen that it cannot be 
readily felt per rectum in the uterus. The fetus, however, may 
be felt by abdominal ballottement. It may also be determined, 
by the presence or absence of fetal movements, whether the 
fetus is still living. 

The OS uteri is generally found quite rigidly closed and in the 
cow it is only with difficultj' that the hand can be passed through 
it. This does not differ materially from the normal condition of 
the cervix uteri in the cow. 

The great weight of the accumulated fluid and the debilitated 
state of the animal cause it to lie down a great deal. When the 
amount of fluid becomes very great, it is frequently necessary to 
aid the cow in regaining her feet, and finally, as the disease 
advances, the patient becomes wholly unable to get up, even 
with assistance. 

The diagnosis of the disease must depend largely upon the dis- 
tension of the abdomen, the dullness upon percussion and the ex- 
ploration per rectum. It must be differentiated from dropsy of 
the abdomen, or ascites, and from dropsy of the kidney, or 
hydronephrosis. The latter is exceedingly rare except in the 

pig- 

Ascites is quite rare in our domestic animals, except in the 
bitch. When the fluid is intra-uterine, it may be differentiated 
from that in the peritoneal cavity by rectal exploration. 

The causes of dropsy of the fetal membranes are not well de- 
termined. Generally the disease seems to depend largely upon 
insufficient nourishment or improper diet. Kammermann records 
that, in one year, following a wet summer and consequently dam- 
aged fodder, the number of cases of dropsy of the amnion or 
allantois was unusually large. Our observations have been some- 
what parallel to this and we have noted, in certain stables of 



Dropsy of the Amnion and Allantois 427 

cows, a large percentage of the animals affected with this malady 
in a given year, when the food had been somewhat damaged, and 
consequently afforded insufficient nourishment. 

A very interesting fact in connection with hydrops of the 
amnion and allantois was observed by us among a herd of Short- 
horn cows, with which an American buffalo or bisorl was allowed 
to consort, and a number of which became impregnated by him. 
Almost without exception, during one year, all the cows which 
were in calf by the buffalo perished from hydrops amnii, while 
the other cows upon the farm, of which there were 100 or more, 
did not suffer from the malady. Similar observations have been 
recorded by others. 

The cadaver of an animal which has died from this disease is 
emaciated and anemic. In some cases the abdominal muscles 
may have become ruptured, because of the great weight which 
they have been called upon to bear, in addition to the weak- 
ened state of the muscles as a result of the dropsy. The uterus 
is greatly distended, pale and thin-walled. Kammermann 
has recorded a rupture of this organ, Garreau found the 
membranes destroyed. Harms observed them ruptured, and 
Schutt found plastic clots floating in the fluid. Harms records 
that the fetuses are, as a rule, feebly developed and may also be 
dropsical. The liver and kidneys show appearances of paren- 
chymatous infiltration, The post-mortem appearances have not 
been well studied. Though most of the animals die, they have 
generally been handled before death, the fetal membranes torn 
and the liquid contents expelled or removed, so that the evidences 
of the actual conditions present during life have been largely 
obliterated prior to the death of the animal. 

The course of the disease is variable. Most animals live until 
near the date for the normal close of pregnancy, but they do not 
as a rule give birth to young without aid. In the cow, a large 
proportion of the animals go down and are unable to stand be- 
fore the veterinarian is called and may perish before the time 
for parturition arrives. When gestation continues for the 
normal time, there is an absence of power on the part of the 
mother to bring about the expulsion of the uterine contents. 
The long continued, great distension of the uterus has destroyed 
the contractile powers of its walls. The abdominal walls also 



428 Veterinary Obstetrics 

lose their power of contraction and cannot eiTectively aid in the 
dilation of the os uteri and the expulsion of the fetus and fluids. 
Possibly the debility of the uterus was the cause of the dis- 
ease. When the time for parturition arrives, the patient shows 
some uneasiness and possibly some very slight evidences of labor 
pains, not of a vigorous character. 

The prognosis of dropsy of the amnion is very grave for both 
the mother and the fetus. In mild cases, it may be favorable 
for the mother and a living fetus may be born. In the severe 
cases, the fetus is general]}' too feeble to live after birth. The 
mother, also, is usually so weak and her uterus so flaccid and 
open to infection that she is very liable to perish. Almost 
uniformly, hydrops amnii is followed by retention of the fetal 
membranes, which gives rise to serious complications. 

The gravity of the condition is often very deceptive to the 
owner and the inexperienced veterinarian. The patient is free 
from pain and fever, looks bright and cheerful and may retain a 
fair appetite. 

In mild cases, spontaneous birth may occur, but as a general 
rule assistance must be given in order to bring about the expul- 
sion of the uterine contents. In the very severe cases the ani- 
mals show complete loss of appetite, become unable to rise, and 
soon succumb to the general weakness and decubitis. These 
symptoms are intensified by the interference of respiration caused 
by the pressure of the fluid upon the diaphragm. When the 
abdominal muscles give way and the uterus descends against the 
skin until it nearl}' reaches the ground, or rupture of the uterus 
occurs, as observed by Kammermann, death quickly follows. 

If the dropsy is slight, and the mother does not seem to suffer 
great inconvenience from it, the case may be allowed to go 
without interference until the normal period of parturition has 
been reached. At this time the patient should be closely 
watched and early assistance given in order that birth may take 
place without too great difiiculty or danger. Such mild cases 
are rarely, if ever, diagnosed. 

Whenever the disease is well defined, so that the mother has 
difficulty in getting up when down and is evidently suffering 
seriously from the malady, complete evacuation of the uterine 
cavity should at once be brought about. The os uteri should be 



Dropsy of the Amnion and Allantois 429 

forcibly and carefully dilated until the hand can be passed into 
the uterine cavity, when the membranes should be ruptured and 
the excessive fluids allowed to escape or siphoned out. The pre- 
senting parts of the fetus should be secured by cords and, by 
gradual traction, the further dilation of the os uteri accomplished 
and the fetus extracted. This requires much patience and time, 
but in our judgment should be persisted in until the operation is 
completed and the entire contents of the uterus, except the 
placenta, have been removed. 

In our experience, when we have dilated the os uteri some- 
what and ruptured the membranes, allowing the fluid to escape, 
and then awaited normal labor, we have been disappointed. The 
labor pains have not appeared, the weakened uterus has under- 
gone infection, the fetus has quickly perished, become emphyse- 
matous, its extraction has been made highly difficult, and the 
mother has perished as a result. We believe, therefore, that the 
delivery should be completed as soon as possible after it has been 
begun, and that no interval should be allowed to occur between 
the dilation of the os uteri, the rupture of the fetal membranes, 
and the extraction of the fetus. The effort should be continuous 
from the beginning to the end. 

It should be observed that, in inserting the hand into the 
uterus of the cow, in this disease, before the fetus has been ex- 
tracted, there is a peculiar condition of the organ, which tends 
to confuse the inexperienced operator. In normal pregnancy 
the body of the uterus becomes enlarged and the median partition 
between the two cornua recedes from the cervix. In hydrops 
amnii in the cow, the inter-cornual partition does not recede from 
the cervix, so that, as soon as the hand enters the uterus, it 
comes in contact with this perpendicular partition between the 
two cornua, in a very unexpected place, in close proximity to 
the cervix. This fact should be recognized and injury to this 
structure avoided. 

Harms suggests that, in some cases, the os uteri has retreated 
so far into the abdominal cavity that it cannot well be reached 
to be dilated and that, in such, the animal should be turned upon 
its back in order to bring it well within reach. This position 
also favors the expulsion of the remaining waters. Harms also 
suggests that animals which have suffered from hydramnii 
should not again be used for breeding purposes, although in- 



430 Veterinary Obstetrics 

stances have been recorded where such cows have successfully 
bred. 

In order to overcome the extreme weakness after the extrac- 
tion of the fetus, it is well that stimulants and tonics should be 
administered for a few days. Full doses of strychnia, hypoderm- 
ically, or strong coffee or other stimulants, as a drench, are 
indicated. It is highly essential that the uterus should be 
closely watched and involution favored in everj' way, in order to 
guard against infection. The animal should be given good, 
clean quarters, with abundant bedding, good and abundant food, 
and every possible hygienic care, until fully convalescent. 

Dropsy of the Uterus. Hydrometra. 

Edema of the gravid uterus is extremely rare in domestic 
animals and we find but one case recorded, which occurred in the 
cow. In this instance, cited by Harms, a cow far advanced in 
pregnancy showed symptoms of abdominal pain and died within 
an hour. Post-mortem examination revealed a great infiltration 
of the walls of the uterus, so that they had attained a thickness 
of 8 to JO cm. Upon incision, the infiltrated fluid escaped. 

Dropsy of the Uterine Cavity. Ascitic Hydrometra. 

An accumulation of fluid between the chorion and uterine 
walls is exceedingly rare and the few cases which are related 
are not perfectly clear, but suggest that in some of them the 
writer may have been dealing with hydramnios or hydrallantois. 
It appears, however, that such a condition does rarely occur. 

Schutt'/Gurlt und Hertwig, Vol. 9, Page 199) relates a case 
in which the animal was very feeble and recumbent much of the 
time, but could get up with help. She groaned and was rest- 
less ; respiration was somewhat labored ; her coat was rough and 
her appetite poor. The abdomen was greatly enlarged. The 
motions of the fetus could be distingished and it could also be 
felt by ballottement. Finally the animal could not get up, and 
perished. 

Post-mortem examination revealed a greatly distended uterus 
with normal walls, fetus and membranes, but between the 
chorion and uterus there were 30 quarts of clear, odorless fluid. 

Werner (Berliner Tierarztliche Wochenschrift, 1890, No. 52) 
records a case in which, though the abdomen was increased in 



Pa raplegia 431 

■size, no motions of the fetus could be determined either by 
internal or external exploration. Five days after the first ex- 
amination, there was found in the gutter of the stall a watery 
fluid, estimated at about 5 or 6 large pailfuls. The fetus, about 
the size of a child's head, was removed in the fetal membranes. 
The uterus was washed with a creolin solution and a tonic was 
administered, under which the cow recovered when she was bred 
again, against the advice of Werner. The dropsy of the uterus 
returned, and the cow was sold, so that the observation of the 
-case was interrupted. (Harms, Tierarztliche Geburtshilfe.) 

Paraplegia. 

In the cow, and rarely in other ruminants, there occurs dur- 
ing pregnancy a form of paralysis of the hind limbs, the nature 
of which has not been fully determined. Presumably it depends 
upon a variety of causes. The cause may at times be some in- 
jury or accident to the limbs or spine or to the muscles acting 
upon these. There appears, however, to be some more important 
cause in a large majority of cases. During one winter, in the 
vicinity of Ithaca, N. Y., there was wide-spread complaint from 
paraplegia in pregnant cows. It appeared in numerous dairies 
scattered over a large area and involved, in some herds, as man}' 
as 10% to 15% of the cows. 

In these cases, the disease appeared more or less suddenly and 
the animal would be found lying down unable to rise. Perhaps 
at first she would be able to stand, upon being assisted to her 
feet. This condition might continue for days or weeks, until 
finally she would go down and be unable to rise, even with assist- 
ance. The disease generally appeared two or more weeks prior 
to the average end of gestation and continued until after parturi- 
tion, unless the animal were previously destroyed or succumbed 
to the affection or to some intercurrent complication. The ani- 
mal was bright, lay upon the sternum with the head erect and 
appeared at first quite normal. The temperature was normal, 
the muzzle moist, the pulse and respirations unchanged. The 
bowels were normal or possibly suffered some degree of torpid- 
ity, as would be naturally expected in an animal in the recum- 
bent position. The appetite was good. The fetus was alive and 
apparently normal. 



432 Veterinary Obstetrics 

The Occurrence of this malady could not be traced to any defi- 
nite cause. The cows which were affected were in the stable, 
since the disease occurred during the latter half of the winter. 
As the food upon which they subsisted varied in the different 
dairies, nothing definite as to cause could be determined in this- 
way. The grain upon which the animals were fed was mostly 
imported from the western states and consisted largely of bran,, 
corn meal and brewer's grains or sprouts. The hay was grown 
locally by the farmers, and had been generally damaged during: 
the haying season because of wet weather, so that most of it 
was of an inferior quality and more or less discolored and 
mouldy, but it was not pre-eminently bad. The cows were not 
in good condition. They were not extremely emaciated and 
had not been starved so far as quantity of food was concerned, 
but had been fed somewhat liberally. Yet they were thin in flesh 
and seemed to be weak and wanting in vigor. This condition 
applied alike to the pregnant and non-pregnant animals. The 
damaged hay seemed the most probable cause of the disease. 

Saint-Cyr records similar occurrences. Though he thinks it 
would be improper to speak of them as epizootic, yet they oc- 
curred quite frequently during certain years and in given herds. 

The disease usually persists, should the animal survive, until 
parturition, after which it generally disappears. The tendency 
for it to disappear after parturition seems to be largely due to- 
the decreased load which the animal has to bear because of the 
expulsion of the fetus and its annexes and the decreased drain, 
upon the maternal system when freed from the nutritive demands 
of the fetus. In the diagnosis of paraplegia we must carefully 
distinguish it from other maladies causing similar symptoms. 
We have already stated that paraplegia may be due to some acci- 
dent, such as a strain or other injury to the limbs or .spine. The 
possibility or probability of such injury should be excluded as 
far as possible. 

We have already related that osteomalacie may induce symp- 
toms of paraplegia. It is not readily diagnosed clinically from 
the affection under consideration. They are much alike in 
causes so far as known. If a fracture or lameness occurs with- 
out warrant it may be very suggestive of osteomalacie. 

We should carefully differentiate paraplegia from dropsy of 
the amnion, in which the collection of the fetal fluids may be 



Paraplegia 433 

so great that the animal is unable to rise when down simply 
because of the enormous weight. 

Paraplegia is also to be distinguished from parturient paresis, 
or "milk fever," which in rare cases appears during pregnancy, 
instead of after. The differentiation between the two is not ver}' 
easy, since in a mild form of parturient paresis the animal may 
look bright. Parturient paresis, however, occurs chiefly, in 
those rare cases in which it is seen during pregnancy, only a few 
days prior to the end of gestation, and is usually accompanied by 
a sub-normal temperature, as in the ordinary paresis after 
calving. This will be more fully dealt with under " Parturient 
Paresis." Parturient paresis occurs solely in vigorous, well fed 
cows, while paraplegia not due to accident is seen in improperly 
nourished, anaemic cows. 

There may be difficulty in differentiating between overfeeding 
and paraplegia. It is a well known fact that, in the cow, para- 
plegia is a common symptom of serious disorder and that we 
have more or less complete paraplegia, paralysis and coma fol- 
lowing overeating and the decomposition of food in the rumen. 
The history of the overfeeding should of itself usuallj- serve to 
distinguish between the two maladies. However, the treatment 
is largely alike. 

The prognosis is variable. Paraplegia due to the various 
accidents enumerated is curable in so far as the causes and effects 
are removable. 

In the enzootic outbreaks of paraplegia observed by us, the 
results have not proven satisfactory. The forced decubitis was 
not readily removed during pregnancy and the long wait until 
the advent of parturition led too often to fatal results. Our 
mortality has been high, perhaps largely because our patients 
were too distant and our handling, consequently, wanting in 
proper oversight. 

Parturition, by removing the mechanical weight of the fetus 
and its annexes, perhaps at times including some degree of 
hydrops of the amnion and allantois, exerts a favorable influence 
upon the course of the disease. Parturition also favors recovery 
by relieving the mother from the nutritive demands of the fetus. 
The earlier parturition occurs after the advent of the disease, 
the more favorable the outlook for the patient. 
28 



434 Veterinary Obstetrics 

The treatment of paraplegia of pregnancy should be directed 
toward the securing of the best possible environment for the 
patient and providing abundant nutritious food. The animal 
should be given a comfortable, well bedded dr}^ stall where it can 
not slip when attempting to rise. 

In all cases, an intelligent effort is to be made to relieve the 
patient of superfluous weight. Bulkj' innutritions food should 
be withdrawn and the alimentary tract relieved from any exist- 
ing overload. This may be partly accomplished by means of 
laxative foods, such as roots and bran with an extra allowance 
of salt. But in decubitis there is a constant tendency to digestive 
torpidity, which should be combatted. Strychnine given hypo- 
dermically in doses of one half to one grain, repeated three 
times a day, answers splendidly for an average-sized cow. Not 
only does it overcome the intestinal torpidity, but at the same 
time affords a most effective tonic. It may, with great advan- 
tage, be combined with moderate doses of eserine or arecoline 
until the alimentar}' tract has been satisfactorily unloaded. 
This is preferable to alkaline purgatives and oils, being safer to 
administer, more prompt and efficient in action and probabl}' less 
dangerous to the life of the fetus. 

Enemas, advised by Fleming and others, are of little use in 
ruminants, the principal point for our attack being the gastric 
apparatus, with loo or more feet of intestine intervening. 

Our attitude toward the existing pregnancy is to be carefully 
considered. Whatever the cause of the paraplegia, the presence 
of the fetus, fetal fluids and membranes intensifies the malady 
by the mechanical weight. The nutritive demands of the fetus 
upon the mother add to the gravitj' of the case, especiall}^ when 
we recall the fact that the digestive and nutritive powers of the 
animal are much depressed by the recumbency. 

Shall we hasten parturition ? Our answer should be based 
upon a thorough consideration of all the surroundings. If it 
appears safe to await normal parturition, this should be done. 
If the case is progressing unsatisfactorily and much time must 
yet elapse before parturition is to be regularly expected, pre- 
mature birth should be induced. In some cases this has yielded 
us good results where, otherwise, a fatal termination appeared 
to be the only prospect. 



Amaurosis 435 

The premature evacuation of the uterus having been deter- 
mined upon, the obstetrist, under all due aseptic precautions, is 
to carefully and gradually dilate the cervical canal, rupture the 
fetal membranes, cause the fetal fluids to escape, secure the 
fetus, arrange the presenting parts in the proper position, and, 
exerting sufficient traction upon the presenting parts, gradually 
cause the needed dilation of the cervical canal and complete the 
extraction of the fetus. The process should not be hastened, 
but as gently accomplished as is possible. In our experience, 
the operation in the cow requires for its proper performance 
three to five hours. 

When begun, the delivery should be completed without any 
intermission of effort. Should the cervix be dilated and the 
membranes ruptured, in the weakened condition of the uterus, 
infection of the membranes, death and decomposition of the 
fetus, metritis and sepsis of the mother are extremely liable to 
follow. 

The fetus removed, the uterine cavity, or rather the cavity of 
the fetal membranes, should be flushed out with tepid water in 
order to remove blood coagula and fetal fluids. A small amount 
of carbolic acid or other antiseptic may be added to the uterine 
douche. 

The fetal membranes are to be allowed to remain in the uterus 
for 1 8 to 24 hours, when they are to be mechanically removed, 
if practicable, followed by antiseptic douching of the uterine 
cavity. If the membranes are inseparable except by lacerating 
the maternal placenta, their removal should be further delayed 
and their putrefaction prevented or ameliorated b\^ the frequent 
introduction into the uterus of large volumes of tepid water, to 
which a little carbolic acid has been added. The introduction 
of the tepid fluid not onlj' keeps the organ cleansed but also 
favors its involution and the expulsion of the retained membranes. 

Amaurosis. 

Fleming quotes Riss (Recueil de Med. Veterinaire, 1831), 
who obser^'ed two cases of amaurosis in pregnant mares, which 
appeared late in gestation and disappeared promptly after 
parturition. We have observed one instance of amaurosis 
appearing in a mare late in gestation, but the disease remained 
permanent after parturition. In case the disease was proba- 



43© Veterinary Obstetrics 

bly a result of periodic opthalmia and had but remote, if any, 
relation to pregnancy. 

St. Cyr and other authors refer to the rare occurrence during 
pregnancy, of eclampsia (especially in bitches), parturient 
paresis and mammitis. They have little special significance and 
will be considered later, when dealing with those maladies, occur- 
ring post-partum. 

Rupture op the Prepubian Tendon. 
Edema of the Abdominal Floor. 

Writers on veterinary surgery and obstetrics generally include 
rupture of the prepubian tendon among the ventral hernise, 
without directing special attention to this characteristic and 
very serious lesion with its premonitory symptoms. 

The eventual lesion consists of a transverse rupture of the 
prepubian tendon, immediately in front of the pubis, between 
the two abdominal rings. Both of these rings are usually in- 
volved and, when the rupture becomes complete, obliterated, all 
tissues between the two openings being torn asunder. 

The disease or accident is practically confined to the mare ; we 
have seen one instance in the cow, and have found no record of 
its occurrence in other animals. 

So far as known, the rupture takes place only in advanced 
pregnancy, rarely prior to the close of the tenth, usually during 
or after the completion of the eleventh month. 

The causes, so far as determined, are : 

1. The increased strain upon the abdominal floor caused by 
the presence of the gravid uterus, which represents at the close 
of pregnancy probably 30 to 40 per cent of the total weight of 
the abdominal contents. 

2. Degenerative changes in the tissues of the abdominal floor, 
including the prepubian tendon, closely associated with profuse 
edema of this region. 

3. Very rarely there is a definite history of violence. In one 
instance observed by the author, a mare, becoming mired in deep 
mud with her hind-feet, over-exerted herself in gaining the bank 
of the stream, thus pulling the hind limbs forcibly backwards, 
and with them the pubis, causing its chief anterior stay, the 



Rupture of the Prepubian Tendon 437 

prepubian tendon, to give way. No edema or other evidence of 
disease preceded the accident. 

Almost always there can be no reasonable presumption of 
accident, the rupture being what we may designate as spontane- 
ous and usually comparatively gradual, frequently being pre- 
ceded for days or weeks by premonitory warnings. 

The disease may be more common in draft mares than in those 
of lighter breed, but, as our experience has been largely with 
the former class, the grounds for comparison are not conclusive. 
We have observed the lesion most frequently in idle mares which 
were well fed. 

The first symptom noticed is an extensive edema of the ab- 
dominal floor, beginning just in front of the mammary gland and 
extending thence forward and backward until it reaches from the 
anterior pectorial region to the perineum, covering the entire 
floor of the body for a depth of 2 to 4 inches. The edema pre- 
sents the usual clinical characters, except that it is possibly 
somewhat firmer than generally seen and somewhat more inclined 
to be painful to the touch. 

The exact relationship of the edema to the rupture of the 
tendon is undetermined, our observation leading us to believe 
that the former is an expression of serious degenerative changes 
which are taking place in the deeper parts. The edema appar- 
ently involves the tendon itself from the first and diminishes its 
resisting powers by forcing the fibers apart, as well as weakening 
them directly. 

The movements of the patient soon become restricted to such 
locomotion as is essential, and this is marked by care and delib- 
eration. The restriction of movement may be partly due to the 
mechanical impediment of the edema, but it appears rather to 
result from pain and a premonition of injury. 

This restriction of motion generally precedes the rupture of the 
tendon and is increased as the rupture extends. 

Should the tendon remain intact until relieved of its excessive 
load through parturition, the edema quickly disappears and the 
parts become normal, but in many cases the tendon gives way 
before the foal is born. The mare then succumbs or, recovering, 
is ruined in value. The foal generally perishes. 

When the tendon begins to part between the two abdominal 
rings, characteristic symptoms arise which serve to distinguish 



438 Veterinary Obstetrics 

it from other lesions. The spinal column of the horse forms an 
arch from the first dorsal vertebra to the sacrum. This arch is 
chiefly maintained by the linea alba, originating from the sternum 
in front and ending behind on the pubis, as the prepubian tendon, 
thus acting as a powerful tie. If the prepubian tendon parts at 
the abdominal rings, the arch of the spine can be no longer com- 
pletely maintained and the back drops downwards, as is shown 
at C in Fig. 82, producing lordosis, or " sway back," while the 
pubis becomes displaced backwards. This causes the external 
ilial tuberosity to descend and the ischial tuberosity to become 
displaced upwards, decreasing the slant of the hip, as we have 
intimated at B in Fig. 82, in contrast to the normal slant at A. 

The rupture of the tissues between the abdominal rings oblit- 
erates these and relaxes the fixation of the mammse in them. 
The abdominal tunic also becomes ruptured on the same level, 
the skin becomes greatly stretched, the milk glands are displaced 
downwards and forwards, as indicated by the position of the teat 
atT in Figs. 82, 83, 84 and 85, and the glands become less con- 
spicuous because of the compression from the stretching of their 
-capsule derived from the ruptured abdominal tunic. 

In Figs. 82-84, the displacement is comparatively mild. In 
some cases it is much greater, as shown in Fig. 85, from St. Cyr. 
No other form of rupture could cause such displacement of the 
mammary gland, as it is firmly fixed to the abdominal ring so 
long as that remains intact. 

The umbilicus is also necessarily displaced forwards and down- 
wards, as shown at U in Figs. 83 and 84. The rupture having 
involved the entire prepubian tendon, and the abdominal tunic 
having given way, the rent may extend on either side outwardly 
from the external side of the abdominal ring until it includes the 
entire abdominal floor. Through this great rent, the gravid 
uterus and other viscera drop down upon the skin and skin 
muscles and, pushing the abdominal tunic and musculo-tendinous 
portions of the abdominal floor forwards, bear the skin and skin 
muscle downward until the hernial sac may reach the tarsus or 
even lower. Early in the progress of the lesion, firm upward 
pressure with the hand, in the premammary region, discloses a 
tense hernial touch without a distinct boundary. As the rupture 
progresses, the hernial touch becomes more pronounced. 

The downward displacement of the abdominal viscera, with 



Riipture of the Prepubian Tendon 



4S9 



the backward displacement of the pubis, causes the flanks to 
■sink in and greatly reduces the transverse, diameter- of the body 
at this point. 

The skin and skin muscle tend, by their elasticity, to check or 
stop the progress of the rupture, in which they are aided some- 
what by the resistance of the uterine ligaments and the mes- 
entery, which aid in supporting the visceral weight when the 
organs have become displaced downwards. In some cases in 
our practice, the skin and its muscle did not suffice to stay the 
progress of the rupture, but gave way, cau.sing eventration and 
necessitating immediate destruction of the patient. 




Fig. 82. Rupture of the Prepubian Tendon in the Pregnant Mare. 
A, Acquired slant of hip. B, Estimated normal slant of hip. 
C, Estimated normal spinal line. T, Teat displaced downwards 
and forwards. 



440 Veteri7iary Obstetrics 

In those very rare instances where violence has pla3'ed an 
essential part in causing the rupture, there need be no pre- 
monitory edema. The symptoms appear very suddenly : the 
tumor is large, the pain intense, the expression anxious, the 
body bedewed with cold sweat, the respiration hurried, the pulse 




Fig. 83. Rupture of the Pre-pubian Tendon in the Pregnant Mare. 
Dissected abdominal floor of Fig. 82. 

TA, Abdominal tunic, showing ruptured margin displaced forwards. 

M, Transversalis muscle, the abdominal tunic removed, showing pos- 
teriori}' the ragged margin at point of rupture. 

CC, Sclerotic connective or cicatricial tissue constituting, with the 
skin, the posterior portion of the floor of the hernial sac. 

T, Teats displaced forwards. U, Umbilicus. 



Rupture of the Prepubiaji Te^idoii 



441 



rapid and weak and the patient tends to quickly collapse from 
shock or hemorrhage. 




EG. .84. Rupture of the Prepubian Tendon in the Pregnant Mare. 
Sagittal or median section of abdominal floor, from Fig. 82. 

I, Section extending through pelvis and sternum. 
II, Detail of anterior portion. 
Ill, Detail of posterior portion. 
P,P, Peritoneum. E, Extent of rupture in the abdominal floor. 
A, A, Sub-peritoneal fat, occupying entire area except that comprised 

in E, where peritoneum is absent as a result of the rupture. 
C, Curled connective tissue, the pelvic remnants of the pre-pubian ten- 
don, posterior to the point of rupture. 
C, Cicatrical tissue occupying the space between the ruptured ends of 

the pre-pubian tendon, devoid of peritoneum and adipose tissue, 
T, Displaced teat. U, Umbilicus displaced forwards. 
F, Skin and skin muscle. TA, Abdominal timic. 
M, Transversalis muscle. St, Sternum. 



442 



Veterinary Obstetrics 



The character and extent of the lesions, with the repara- 
tive efforts in a surviving case, are well shown in Figs. 83 and 
84, in which it is seen that the peritoneum, prepubian tendon 
and abdominal tunic have all parted just anterior to the pubis 
and passed forward about half way to the sternum, dragging 
with them, for a part of the way, the teats. Posterior to these 
and occupying the area previously filled by them, is an extensive 
expansion of dense connective tissues, C, which has assumed the 
functions of the ruptured parts. 

In Fig. 84 it is shown that the subperitoneal fat, A, does not 
invade the ruptured area, E, but seems to depend for its forma- 
tion upon the presence of the peritoneum. 

The prognosis of complete rupture of the prepubian tendon 
is very grave, since most mares, along with their foals, perish 
before the conclusion of the pregnancy during which the rupture 
occurs. 




Fig. 85. Rupture of Pre-pubian Tendon. Mare. 
A, B, Hernial sac. C, Teat displaced downward. and forward. (St. Cyr. ) 



If the parturition, following the pregnancy during which the 
accident occurred, is safely passed, the animal may thereafter 



Rupture of the Prepubian Tendo7i. 443 

breed without danger or difficulty, but is so unsightly that her 
value for this purpose is seriously diminished. She may do 
ordinary slow work, but here the unsightliness becomes still more 
serious and few persons are willing to use such an animal. 

The foal in the uterus at the time of the rupture usually 
perishes, but, if the mare survive, succeeding foals may be born 
with the same safety as though the lesion did not exist. 

When a threatened or beginning rupture is promptly recognized, 
and appropriate measures for prevention or relief applied, the 
prognosis is highly favorable. 

The advice of Fleming, that extensive edema of the abdominal 
floor in pregnant mares is unimportant and may be safely ignored 
and that the disease will quickly disappear after parturition 
with little or no attention, has led, when followed, to serious 
disaster in our hands. 

Edema in advanced pregnancy in the mare is a serious 
condition, which calls for prompt and energetic handling. 
It should always be regarded as a precursor of rupture of the 
prepubian tendon. If left without attention, many of the mares 
will succumb from rupture ; if proper attention is rendered the 
danger will be almost wholly averted. 

Treatment. In the handling of threatened rupture of the 
prepubian tendon, mechanical support of the greatly overloaded 
aud weakened abdominal floor should receive our first considera- 
tion. Whenever extensive edema occurs along the floor of the 
abdomen in a mare far advanced in pregnancy, unless the condi- 
tion is clearly referable to unimportant causes, we urgently advise 
the immediate application of an abdominal bandage of canva.ss or 
other strong material. The bandage should be constructed with 
8 or ID strong buckles and billets and fitted to the oval form of 
the abdomen by means of a gore placed in the center of the canvas. 
We do not at all times have the required time for properly con- 
structing the bandage, and, in order to avert immediateh' threat- 
ening disaster, an emergency, many-tailed bandage should be 
quickly applied. In order to adapt this to the oval form of the 
abdomen, the tails should be crossed so that the most posterior 
of one group of tails shall be tied to one of the most anterior of 
the other end, and the remaining tails united upon a similar 
plan. The spine and the point where the ends of the bandages 
are tied should be amply padded to avoid pressure-necrosis of the 



444- Veterinary Obstetrics 

skin from the buckles or knots, and should be carefully read- 
justed daily or as often as conditions may dictate. 

In applying the emergency bandage to cases where the tendon 
has already parted or its rupture seems very imminent, it is im- 
portant to get it quite tight. In order to facilitate this, it is best 
to tie a solid loop in each upper tail, that is, in each tail of the 
bandage which passes over the back, through which each lower 
tail may run as through a pulley. The bandage cannot be properly 
tightened at the first effort. One after another of the tails is to 
be tightened as well as convenient at the first tying. As soon as 
all are fastened, go back to the first ones and tie them over again 
and continue the process until the desired support is secured, and 
the great weight of the viscera lifted from the abdominal floor 
and largely transferred to the spine through the bandage. 

The decrease in the weight of the abdominal viscera is also of 
very great importance. We should lessen the weight of the 
digestive viscera by withdrawing all bulky food and replacing it 
with limited quantities of concentrated aliment. We might 
hurry the unloading of the intestinal tract by the aid of small 
doses of eserine sulphate, or arecoline, such as half-grain doses 
every half hour, until the desired effect has been induced. 

If the tendon has parted, the induction of premature labor 
should receive careful consideration. 

As a rule, the foal perishes unless aid is given. Even under 
close watching, the uterine contractions go on unobserved and 
cause the death of the foal through separation of the placenta 
before adequate expulsive force is brought into play. Most of 
the expulsive power is destroyed when the abdominal floor gives 
way, leaving the uterus alone to expel the fetus. It therefore 
seems desirable to anticipate this danger to the fetus by bringing 
about artificial delivery not later than the completion of the 
eleventh month, in a wa}' to best safeguard the life of the fetus. 
The premature delivery is best effected by carefully dilating the 
OS uteri with the hand ; grasping and, if necessary, cording the 
fetal parts presenting, and applying moderate traction to com- 
pensate for the lost expulsive power of the abdominal muscles. 
It is to be remembered that it is best to have the patient in lateral 
recumbency during delivery, since this raises the fetus approxi- 
mately to a level with the pelvic inlet. When the mare is in the 



Hernia of the Uterus 445 

standing position the fetus drops down below the pelvis, through 
the immense rupture, and rests upon inert parts. 

If premature delivery is not decided upon, the mare should be 
closely watched and prompt aid should be given at the first signs 
of labor. 

After delivery, the bandage may be removed at once and the 
case dismissed if the tendon has not ruptured ; if it has ruptured, 
the bandage should be readjusted and retained until such time 
as the ruptured tissues have healed and the weakened abdominal 
floor has been reenforced by the new formation of connective 
tissue, as indicated at C, in Fig. 84. 

The mare may be retained until the foal is ready to wean, 
and then destroyed ; she may be kept permanently as a brood 
mare, with reasonable assurance that thereafter she will foal un- 
aided ; or she may be used at moderate work without discomfort. 

In the very severe cases, where the skin and skin muscles are 
giving way so that eventration is imminent, or where accompanied 
by shock and serious internal hemorrhages, the mare should be 
promptly destroyed, after performing Caesarian section if it is 
desired to save the foal. 

Hernia of the Uterus or Hysterocele. 

As Hernia of the Uterus, we describe a condition of varying 
significance, due to any cause, except rupture of the prepubian 
tendon which we have already described in the preceding chapter, 
by which a portion or all of the gravid uterus escapes through 
the muscular walls of the abdomen. This accident or condition 
may occur in any of the domestic animals and at any point of the 
abdominal floor. Any ventral hernia may become occupied by a 
portion of the gravid uterus in any of those animals where the 
non-gravid organ is of sufiicient length to drop into the opening 
so that impregnation may occur in the herniated organ. The 
hernia may also occur later, when the gravid organ is borne down 
by the weight of its contents. If the hernial ring is sufii- 
ciently large to allow the escape of a fetus or fetuses through it, 
the gravid uterus drops into the hernial sac. The causes are the 
same as those of other herniae, and have no special relation to ob- 
stetrics except that the fetus passes through the hernial ring, 
becomes developed within the hernial sac and offers obstacles to 
birth. 



446 Veterinary Obstetrics 

The hernia may be due to traumatism, or to a congenital defect 
in the abdominal wall, either at the umbilicus or the inguinal 
ring. Sometimes, in the development of the fetus, the umbilical 
ring remains so large that the abdominal viscera permanently 
protrude through it, against the skin. Such an animal, when 
grown, if permitted to become pregnant, and the hernial ring is 
very large, is liable to uterine hernia and the fetus or fetuses 
may develop in the hernial sac. Hernias of such dimensions are 
rare in our larger domestic animals, but umbilic hernias are occa- 
sionally met with, in the mare, of such size that, were she allowed 
to go without treatment and be bred, a uterine hernia would in- 
evitably result. 

In some animals, especially in the bitch and sow, the ovary 
and uterine cornua pass from their ordinary position through the 
inguinal ring and reach the location of the testicle in the adult 
male, in the perineal region. As a consequence, in case of preg- 
nancy, the young may develop in this herniated portion of the 
uterus, outside the abdominal cavity. 

The diagnosis of uterine hernia is comparatively easy. The 
fetus or fetuses are so superficially situated that they may be 
recognized by palpation. Sometimes the tumor is not reducible 
because the fetus has become larger than the hernial ring and 
consequently cannot be returned into the abdomen by pressure. 

The significance of these hernise will vary greatly according to 
conditions. If occurring as the result of a recent accident, when 
no hernial ring or sac has become established, the hernia tends 
to enlarge rapidly because of the presence in it of the gravid 
uterus and other viscera. In any hernia with a well established 
ring and sac, into which the gravid uterus enters, the tendency 
is for the sac to continue to grow, but for the ring to remain un- 
disturbed. They have little risk generally for the life of the 
mother until parturition comes on, when they may become a 
serious menace to the lives of both mother and fetus. If the fetus 
should be of too great size to readily pass through the hernial 
ring or if there be an extensive hernia of recent date which has 
destroyed the expulsive powers of the abdominal walls, active 
obstetric interference may be demanded in order to save the lives 
of parent and offspring. 

It is inadvisable, as a rule, to attempt to breed animals which 
have hernise of such a character that it is probable that a fetus or 



Rupture of the Gravid Uterus. 447 

fetuses may find lodgement therein. When a ventral hernia 
occurs during pregnancy, the parts should be immediately and 
•carefully supported by a wide bandage so as to prevent the ex- 
tension of the newly-formed rupture. Females having congen- 
ital hernia at the umbilicus or inguinal ring should not be bred 
for zootechnic reasons, as well as because of the probability of 
obstetric diflSculty. 

When such animals have been bred, however, and the question 
of the preservation of the life of the mother or fetus arises, we 
may bring about artificial abortion in behalf of the life of the 
mother or may resort to hysterotomy with a view to saving the 
life of the fetus and perchance of the mother also. 

Rupture of the Gravid Uterus. 

Rupture of the gravid uterus is not common in domestic 
animals, though doubtless it occurs more frequently than re- 
cognized. It may occur from a great variety of causes, may be 
of any degree and accompanied or followed by various symptoms. 

On page 58 we have already alluded to the record of the rupture of the 
non-gravid uterine cornu of a cow during coition. On page 260 we have 
noted a case where a veterinarian, through error, ruptured the uterus 
in attempting to dilate the cervical canal in a case of sterility. On page 
424 we have mentioned the possibility of uterine rupture in dropsy of the 
amnion. 

On page 417 we have alluded to those cases of rupture of the 
gravid uterus in which the fetus has escaped more or less com- 
pletel}' from the uterine body without causing fatal lesions, the 
fetus and its membranes not undergoing decomposition but re- 
maining indefinitely as an inert body to constitute a form of 
extra-uterine pregnancy. 

In a subsequent chapter, ' ' Torsion of the Uterus, ' ' we shall 
have occasion to speak of a transverse rupture of the uterus or 
vagina as a consequence of the revolving of the gravid organ 
upon its long axis to such an extent as to cause its tissues to 
part, leading to various complications of a very grave character. 

Rupture of the gravid uterus may occur as a result of emphy- 
sema of the fetus, which will be considered later. 

When dealing with the subject of dystocia we shall have occa- 
sion to di,scuss the not infrequent uterine ruptures due some- 
times to mal-position of the fetus, far more frequently to errors 



448 Veterinary Obstetrics 

on the part of incompetent persons while attempting to overcome 
difficult labor. 

When labor has been completed, ruptures of the uterus may still occur 
through incompetent handling of retained placenta or as a consequence of 
prolapse of the uterus. 

Since these various ruptures are sufficiently considered in their 
proper places, it is desirable that we should here confine ourselves 
to the comparatively rare instances of rupture of the gravid uterus 
not included in the other classes of cases mentioned. We wish, 
consequently, to draw attention here to those cases of rupture of 
the gravid uterus not due to torsion or to diseases of the fetus, 
uterus or fetal membranes and occurring independently of dystocia 
or attempts at delivery. Saint Cyr terms these longitudinal 
or oblique ruptures. 

The causes are variable. Generally, so far as known, such 
ruptures are the result of impacts of blunt bodies against the 
abdominal floor, such as the kick of a horse, the impact of a 
wagon pole, falling upon projecting stones, etc. 

The symptoms are not at all uniform but dependent upon the 
extent of the rupture and other conditions. 

The rupture may be incomplete, the mechanical insult or other 
cause serving merely to induce a more or less serious strain or par- 
tial rupture of the muscular walls of the organ. Such a lesion 
maj' result in appearances of ill-health, possibly slight colic or 
other symptoms leading to the belief that some digestive disturb- 
ance exists. 

I,ater the weakened uterine walls may give way either as a re- 
sult of the weight of the fetus or the greatly augmented intra- 
uterine tension owing to uterine contractions. Then follow 
rapidly symptoms of great depression, weak pulse, accelerated 
breathing, cold body surface with probably cold sweats, followed 
in a few hours by death. 

If the fetus, fetal membranes, and liquids are aseptic, the 
symptoms induced are chieflj' those of shock and internal hemor- 
rhage. If the uterine contents are infected, and these contents 
suddenly escape into the peritoneal cavity, there follows promptly 
the very grave depression of acute peritonitis. 

External manipulation of the abdomen may reveal the fetus 
free within the abdomen and the fetal riuids outside the uterus 
presenting the appearances of ascites. 



Prolapse of the Vagina 449 

Exploration per vaginam reveals no data of value except the 
cervix be dilated so that the hand may be passed into the uterus, 
when the absence of the fetus in the uterine cavity becomes evi- 
dent. The membranes have more or less completely escaped and 
the rent in the uterus is easily recognizable. 

If the cervix is clo.sed, the hand introduced into the rectum 
may yield all needed data for a positive diagnosis. The uterine 
body, somewhat retracted and without fetal contents, is recog- 
nizable. Outside the uterus, lying more or less free in the peri- 
toneal cavity, the fetus may be detected. 

The treatment of rupture of the gravid uterus in domestic 
animals has not yet been made practical. In most cases of the 
character here described, the patient dies without a positive diag- 
nosis having been reached, and the actual nature of the accident 
is only revealed post mortem. 

If recognized during the life of the patient there is scant basis 
for hope of overcoming it by surgical means. Caesarian section 
is indicated, if thereby there is a hope that the fetus and its 
membranes may be removed, the hemorrhage from the ruptured 
uterine walls controlled and the life of the mother saved. (The 
operation of laparotomy is described later when dealing with ob- 
stetric operations. ) In such cases, the operation should include 
the removal of the fetus and its membranes, and the closing of 
the uterine walls, with the consequent arrest of hemorrhage. 

Ante-partum Prolapse of the Vagina. 

Prolapse of the Vaginal Portion of the Uterus. 

Prolap.se, or eversion, of the vagina is observed in the preg- 
nant cow and ewe and more rarely in other domestic animals. 
Fleming attributes the occurrence of this prolapse during preg- 
nancy to a relaxation of the genital organs, and claims that it 
occurs mostly in those animals of a lymphatic temperament 
which are good milkers, have wide pelves and are fed abundant- 
ly upon bulky food. He also believes that cows which are kept 
on sloping floors are liable to this disease and that injuries of 
various kinds may cause it. He claims that it occurs chiefly in 
adult animals which have previously given birth to young. We 
have observed it also in primiparas. The disease usually appears 
29 



450 Veterinary Obstetrics 

during the later stages of gestation, sometimes only a few days 
prior to parturition, while at other times it may precede the 
advent of labor two to four weeks. 

The actual cause is not well known. We have observed it 
more frequently in the ewe than in the cow. In the ewe it 
can not well depend upon lying upon a floor sloping backward. 
Sheep are not coniined in stanchions and ordinarily lie upon a 
level floor, so that there is no sloping backward of the body. So 
far as we have observed, the affection is seen almost entirely in 
closelj'' housed pregnant animals. We have especially noted the 
affection in ewes which were being bred for winter, or "hot 
house " lambs. In these cases the ewes are bred about August 
or September, so that they may give birth to lambs during mid- 
winter, which are fitted for the early market when prices are 
high. The ewes are closely confined in very warm stables and 
highly fed. Under these conditions we have found as high as 5 
to 10% of a herd of ewes affected with this malady. So far as 
we have observed, the conditions under which the disease arises 
in the cow are similar. We do not recall having seen a case of 
prolapse of the vagina in a pregnant animal, except it was closely 
housed or had met with some accident. 

The symptoms of the malady consist essentially of a prolapse 
of the vagina, which projects more or less beyond the vulvar 
opening as a bright, red tumor. After it has been prolapsed for 
a period of time it becomes swollen and the mucosa much thick- 
ened and very greatly' irritated. The prolapsed part may become 
covered over with dried blood clots, bedding and dirt of various 
kinds, accompanied by more or less suppuration. During the 
earlier stages and in very mild cases, the prolapse may be visible 
only when the animal is lying down, and disappear spontaneously 
when she gets up. If the tumor remains when the animal is 
standing, and is pushed back by the hand, the vulvar opening is 
abnormally large, the result of the prolonged stretching of the 
sphincter muscles by the presence of the tumor. 

In many cases the prolapse does not cause great inconvenience 
to the animal. In others there is considerable irritation, with 
straining, which increases the size of the tumor and gradually 
results in systemic disturbances which may cause the animal to 
lose flesh and vigor and finally to succumb. 

Judging from our clinical observations, the essential causes of 



Prolapse of the Vagina 451 

the disease are a depression of the general vigor of the animal by 
the close confinement and overfeeding, combined with a height- 
ened intra-abdominal pressure, due to the presence of the gravid 
uterus, intensified by bulky feeding. These lead to an infection 
of the vaginal mucosa, which induces swelling accompanied by 
straining — a chronic catarrh of the vagina with exalted intra- 
abdominal pressure. Sometimes the tumor projects for a consid- 
erable distance beyond the vulva and the cervix uteri may even 
appear and protrude beyond the vulvar lips. (Prolapse of the 
Vaginal Portion of the Uterus. ) In most cases, especially in the 
ewe, the entire circumference of the vagina protrudes, as an 
irregular, ring-like tumor. In other cases, especially in the cow, 
only the floor of the vagina protrudes. Along with the vaginal 
floor the urinary bladder may be everted and protrude beyond 
the vulvar lips enclosed within the vagina, constituting vesico- 
vaginocele. In this condition, the urethra is found close to the 
lower commissure of the vulva and its canal extends upward and 
backward into the urinary bladder, which now lies reversed, with 
its fundus extending backward. 

When the prolapsed organ attains a large size and remains 
exposed for a long time, it becomes excoriated and ulcerated and 
the mucous membrane vastly thickened .so that it may be ex- 
tremely difficult to bring about its replacement. 

Prognosis. Once established, prolapse of the vagina in preg- 
nant animals persists until parturition is completed, unless over- 
come by proper handling. There is no visible tendency toward 
spontaneous recovery. On the contrary, the malady tends to 
become aggravated with time. 

The protruding organ comes in contact with bedding, manure 
and other infecting and irritating objects. Occasionally it is 
rubbed against the walls of the building or other objects, causing 
laceration. Feces from the patient must pass over the tumor and 
soil it. The tail is constantly in contact with the tumor and 
serves to abrade it. 

Under these conditions the prolapsed organ becomes more and 
more inflamed, thickened and painful. Straining occurs fre- 
quently. The mucosa becomes greatly thickened and dark col- 
ored, and more or less gangrene may occur. 

When vesico-vaginocele exists, the inverted position of the 
bladder, outside the body cavity, renders urination very difficult. 



452 Veterinary Obstetrics 

All aid normally coining from the compression of the abdominal 
walls is lost and the expulsion of urine must be accomplished by 
the contraction of the bladder walls alone, against serious obsta- 
cles to the escape of the urine through the urethra. The accu- 
mulation of urine in the bladder, causing the distension of the 
organ, increases greatly the size of the prolapse and intensifies 
the suffering of the patient. 

The straining consequent upon the prolapse tends somewhat 
toward dilation of the cervical canal and favors the extension of 
the infection from the vagina along the cervical canal into the 
uterine cavity. Such infection tends to sooner or later bring 
about the death of the fetus, followed by its septic decomposition. 

The expulsive powers of the genital canal are at once weakened 
so that, should the fetus perish, its expulsion is doubtful. In- 
stead it is liable to be retained, decompose, and induce fatal sep- 
sis of the mother. This is especially true in the ewe. 

The affection in the ewe is highly fatal, and most of the ani- 
mals succumb unless handled carefully and early. In the cow the 
affection has, in our hands, proven more amenable to treatment. 
When the vaginal portion of the gravid uterus is so far displaced 
that it protrudes beyond the vulva, the gravity of the malady 
becomes heightened. 

A serious feature of the malady is the weakening of the in- 
flamed vaginal walls. In some cases they become so fragile and 
inextensible that they rupture during the passage of the fetus 
through the vagina or during manipulation by the obstetrist or 
others. The accident ends in fatal peritonitis. 

Treatment. — The treatment of this malady will vary materi- 
ally in individual cases. If it is observed that the animal is 
forced to lie with the posterior parts depressed, as in case of a 
cow in a sloping stanchion, the declivity of the stall floor should 
be corrected. Since the exalted intra-abdominal pressure has 
much to do, in a mechanical way, with the causation of the dis- 
ease, this tension should be largely overcome by giving a con- 
centrated diet in limited amount and of a laxative character, to 
reduce the volume of the abdominal contents as far as practicable. 

In those cases where the disease is well established and the 
mucous membrane inflamed, general precautions do not serve to 
overcome the disease. The prolapsed organ must be returned to 
its position promptly and means applied which will cause it 



Prolapse of the Vagi?ia 453 

to remain in its normal situation. In order to maintain the organ 
in position, we need overcome the straining, due to the pain, and 
the infection. Before the prolapsed organ is replaced into its 
position it must be cleansed thoroughly. After its reposition it 
is to be straightened out in its normal situation ; the replacement 
must be as complete and perfect as possible. After it has been 
replaced, we should introduce into the cavit}' of the organ reme- 
dies which will overcome the infection and ameliorate the pain. 

The reposition of the extruded organ is not always easy, be- 
cause of the straining. First, the part should be bathed with a 
tepid antiseptic solution, for which lysol is especially useful be- 
cause of its unctuous character. Care is to be taken that the 
antiseptic is not too irritant. The lysol solution should not ex- 
ceed I %. It may even be omitted and tepid water alone used. 
If the organ is very irritable and painful and its reposition causes 
great resistance we may apply to it one of the local anaes- 
thetics, such as cocaine, or eucaine in order to overcome the re- 
sistance in returning theorgan and to diminish the straining after 
it has been replaced. An addition of adrenalin to the anaes- 
thetic solution blanches the mucosa and decreases the congestion. 
The replacement of the organ in the cow should be brought 
about by gentle and careful pressure with the palms of the hands, 
until it has retreated within the vulva, when one hand should be 
introduced and the walls of the organ straightened out in their 
normal position. If for any reason the animal should be re- 
cumbent, great difficulty may be found in replacing it. When- 
ever possible, the animal should be caused to stand, preferably 
with its hind feet upon higher ground than the fore-feet, so that 
the anterior part of the body slopes downward and the abdominal 
viscera drop forward away from the pelvis. 

The ewe, or other small patient, should be seized by the hind 
legs and suspended with the head downward, when the diseased 
organ will return to its position spontaneously or with very slight 
pressure. After the organ has been replaced, the operation may 
be completed by pouring into the vagina, through a funnel or 
tube, a tepid antiseptic solution. This tends to- smooth out all 
irregularities and make the replacement complete. In the ewe 
we have found that a i-iooo solution of corrosive sublimate is 
not so highly irritant in the diseased vagina as it would be in 



454 Veterinary Obstetrics 

the normal organ, and is usually borne without apparent 
irritation. 

In order to prevent a recurrence of the eversion, and bring 
about disinfection and a decrease in the irritation of the part, we 
have found iodoform, or iodoform and tannin, highly beneficial. 
In the cow, the powder, enclosed in a gelatine capsule, which 
maybe opened with the hand, maybe introduced deeply into the 
vagina and scattered about in the cavity. In the ewe or other 
small animal the powder can readily be dropped into the vagina 
by holding the vulvar lips apart with retractors or by introduc- 
ing a long pair of dressing forceps deeply into the vagina and 
opening them, holding the walls of the canal apart and dropping 
the powder into the organ, while the patient is suspended by its 
hind limbs. 

Another effective means for applying iodoform and tannin or 
other astringents or local anaesthetics is by means of supposito- 
ries, which may be made by mixing the desired drugs with tallow 
and enough wax to give the proper consistency, and then pour- 
ing these into a suitable mould, according to the species and size 
of the animal. After they have hardened, they are introduced 
into the vagina. Such treatment is very soothing to the irritated 
organ and does much to overcome the infection and straining, 
which go hand in hand. 

Fleming and others recommend the application of bandages, 
trusses or sutures to retain the diseased organ in position. We 
have not found these very satisfactory because there is no way, 
by either plan, to prevent the vagina from being pushed out 
against the mechanical devices, thereby causing irritation by 
pressure against these objects. We have not successfuUj' con- 
trolled the straining until we have eliminated its cause or causes — 
until we have overcome the infection and inflammation. When 
this has been accomplished, the disease ceases. In other cases 
Fleming advises the use of the ring pessary, but the application 
of this can only intensify the infection. While it may keep the 
vagina in place, it does not cure, but merely disguises the exist- 
ence of the malady. 

It is not improbable that the prolapse is often due to fetal 
death. The general assumption is that the prolapse induces the 
death of the fetus and thereby complicates the disease, but the 
reverse may be true. We know that, following parturition,. 



Prolapse of the Vagina 455 

endometritis frequently induces vaginal prolapse, which persists 
until the endometritis is definitely relieved, and this fact raises 
the question whether a macerating fetus in the uterus may not 
similarly cause prolapse of the vagina in the pregnant animal. 
If so, it would evidently be bad surgery to apply mechanical 
devices to overcome a prolapse dependent upon causes still 
existing, which the means applied would intensify, instead of 
overcome. 

The bandage, truss, suture, pessary or other mechanical means 
for retention not only tends to aggravate the malady in many 
cases, but is a constant danger for the animal when parturition 
arrives. There is one redeeming feature in all these mechanical 
appliances when parturition arrives : they are each and all thrust 
aside ; sutures are torn out, with resulting deformity ; and labor 
generally proceeds in spite of the obstacles. This indicates that, 
if the irritation in the vagina is sufficiently great, each of these 
means is ineffectual in retaining the prolapsed organ. The ap- 
plication of each of these mechanical devices will be described 
under "Prolapse of the Uterus" as a post-parturient accident. 

We have suggested above the use of astringents in combina- 
tion with iodoform, applied to the diseased organ. iVstringents 
are not to be carried too far. If applied too abundantly as a 
powder or in aqueous solution they may prove too dessicant and 
harden the vaginal walls. Pushed too far, they may even cause 
dessicant necrosis of the mucous and muscular walls. Such des- 
sication endangers the life of the patient by inviting a rupture of 
the rigid or necrotic vaginal walls at the time of parturition. 
The vaginal mucosa should be kept moist. If necessary, the 
softness and pliabilitj' are to be maintained by the application of 
oil or heavy fats with the iodoform or other disinfectants. 

Systemic medication should not be neglected. We have indi- 
cated that amongst the chief causes were a general atonic state 
combined with close confinement and heavy feeding. 

The intestinal tract should be promptly and judiciously un- 
loaded in order to overcome the abnormal intra-abdominal ten- 
sion as well as to relieve the digestive system from an overload of 
aliment demanding digestion. If the object can be promptly at- 
tained by the use of laxative foods, the administration of drugs 
may not be demanded. Generally, the veterinarian is not war- 



456 Veterinary Obstetrics 

ranted in permitting such delay, but should promptly administer 
purgatives. The promptest and safest of these are the alkaloids, 
eserine and arecoline. Given in small doses they act within an 
hour, and if they fail to do so the dose may then be repeated. To 
an ordinary cow ^ to i grain of arecoline or eserine may be 
given. The ewe may take ^ to i of a grain, repeated in in- 
creased doses until the desired effect is obtained. Saline cathar- 
tics may be used instead, but they are very slow in action and 
cause disagreeable disturbances of the appetite. They have 
greater danger for the life of the fetus. 

The general tone of the system should be favored by the ad- 
ministration of tonics, especially of nux vomica or strychnine. 

When the affected animal has reached the" normal duration of 
gestation and the prolapse is severe and inveterate, artificial de- 
livery should be induced without delay. The os uteri should be 
gradually dilated and the fetus secured and brought away with 
light and careful traction. 

We are strongly inclined to hasten parturition, especially if 
the normal duration of pregnancy has been about completed. 
The size of the ewe may render this difficult. If the ewe is large 
and the obstetrist's hand small, the task is greatly lightened and 
the operation rendered more safe. , The operation should be 
carried out in the same manner as described on page 428. When 
the smallness of the vulvo- vaginal canal or the large size of the 
operator's hand precludes artificial delivery through the genital 
canal, hysterectomy may be considered and applied if deemed 
judicious. We shall describe this operation among "Obstetric 
Operations." 

A heifer entered in our ambulatory clinic had suffered seriously 
from vesico- vaginocele for 24 hours. The animal had reached the 
end of the ninth month of gestation. When we were called, she 
was lying prone in the stanchion, unable to rise, even with assist- 
ance. She was somewhat emaciated, apparently very feeble, 
and there was possibly some degree of hydrops amnii. The floor 
of the vagina, within which was the bladder filled with urine, 
was extruded through the vulva and returnable only with great 
difficulty. It was impossible, from the beginning, to retain the 
organ in position after its return and it was evident that the only 
hope for the patient lay in immediate delivery. 



Hemorrhage from the Gravid Uterus 457 

The animal was dragged from the stanchion to a suitable place 
for operating, where the posterior parts could be somewhat ele- 
vated. After much tedious and patient labor, the os uteri was 
dilated and the fetus removed. The afterbirth was left in the 
uterus and its cavity was filled with a warm disfecting solution. 
The prolapsed organ remained in position without any mechan- 
ical appliance and the animal, relieved of the weight of the fetus, 
was soon able to regain her feet and made an uneventful recovery. 

In all cases of this malady, we would advise that the chief 
effort be directed toward overcoming the causes and that close 
attention be given to the cleanliness of the parts and to keeping 
them in position by the gentlest possible means. In many cases 
the repeated replacement and dressing of the parts may be essen- 
tial and, in some comparatively rare cases, the truss or sutures 
may be allowable. However, we would urge the avoidance of 
mechanical appliances, so far as practicable. 

It must be borne in mi':d, also, that the disease is due very 
largely to clo,se housing and consequently we may accomplish 
much good by causing the animal to take invigorating exercise. 
This should not be severe but should be abundant and regular. 
Such exercise aids in many ways : it stimulates the action of the 
bowels and decreases the fullness of the abdomen ; it invigorates 
the general system and imparts an increased tone to the aifected 
organ ; and it serves to direct the patient's attention from irrita- 
tion in the part and thus prevents straining. The movements of 
the animal further tend to bring about a correct position of the 
uterus and vagina. 

Metrorrhagia . 
Hemorrhage from the Gravid Uterus. 

Hemorrhage from the gravid uterus is very rarely observed 
in our domestic animals. Carsten-Harms records the accident 
in the cow and mare, and admits its occurrence in all domestic 
mammals. The symptoms consist fundamentally of colic, strain- 
ing similar to labor pains and an escape of blood from the genital 
organs. The symptoms are not constant and any one of them 
may be absent in a given case. Should hemorrhage occur from 
the cervix, the blood may escape from the vulva, and, if moderate, 
no symptoms occur except the visible hemorrhage itself. It 
may even be that colic or other disease which might later be re- 
garded as a symptom of metrorrhagia actually causes the hemor- 



458 Veterinary Obstet7'ics 

rhage and may precede it by several days. The straining may 
vary greatly in degree and may not be very prominent. 

The hemorrhage from the vulva will necessarily vary greatly ac- 
cording to the case ; in some instances it may be very extensive 
and apparent, while in others the blood may all be retained in 
the uterine cavity. If the hemorrhage is very extensive, whether 
the blood escapes from the uterus or not, it produces the usual 
symptoms of internal bleeding, such as colic, imperceptible pulse 
and blanched mucosa. In such severe cases the animal necessarily 
becomes very weak and staggers. The surface of the body be- 
comes cold, and there is profuse sweating in the mare. The 
heart-beat is violent but the arterial impulse is weak. 

The. diagnosis of uterine hemorrhage, in pregnant animals, is 
not easy except by manual exploration. It is necessary to de- 
termine the source of the bleeding, and the manipulations 
necessary to this are sometimes undesirable. We were once en- 
gaged with a very serious case of dystokia in a mare, which 
occupied our time for some six hours. The work was performed 
in close proximity to other pregnant mares. When we had 
finished our work we observed that another mare, which was 
almost ready to foal, was discharging blood from the vulva and 
was considerably excited. The mare was secured and quieted, 
after which she seemed to be well in every respect ; there was 
no pain, the pulse and temperature were normal and the animal 
appeared perfectly well except for the discharge of a moderate 
quantity of bright red blood from the vulva. The flow soon 
stopped and it seemed to us inadvisable to undertake the manipu- 
lations necessary to determine the source of the bleeding, whether 
from the uterus, vagina, bladder or some other part. We con- 
sequently desisted from making any examination and allowed 
the case to go without interference, with the result that preg- 
nancy was completed without further incident and a living foal 
was born. 

We hold, therefore, that it is not essential in all cases to make 
a definite diagnosis when manipulation might imperil the life of 
the fetus. Under the circumstances which we have related, 
manual exploration of the vagina to determine the source of the 
hemorrhage would, in our judgment, have been unnecessarily 
hazardous, more so than had the animal not been greatly excited. 

The hemorrhage may cease and gestation continue for the 
normal period of time and. either living or dead young be pro- 



Hemorrhage from the Gravid Uterus 459 

duced. There may be but a single hemorrhage or it may recur 
several times. In severe cases, the hemorrhage may prove fatal 
to the mother. 

The causes must be referred to a rupture of some of the uterine 
vessels, which may be due to the presence of a tumor or other 
disease or, as is probably most frequently the case, to some trau- 
matic injury. 

The prognosis of uterine hemorrhage in the pregnant animal 
is usually very grave, alike for the mother and the fetus. 

The treatment will depend greatly upon circumstances. First 
of all, we should secure the most absolute quiet possible in the 
hope that the blood may form a thrombus and the hemorrhage 
from the wounded vessels cease. Harms recommends an applica- 
tion of cold water or of cooling mixtures or ice-bags to the pos- 
terior part of the abdomen in the vicinity of the uterus, by which 
he hopes to favor the formation of thrombi. Ergot and hydrastis 
Canadensis may be given internally as styptics, but their effect is 
not always satisfactory. When the hemorrhage is very threat- 
ening, it may be desirable to bring about immediate delivery of 
the fetus. We would have one or more of three objects in view 
in bringing about the evacuation of the uterine cavity, i. We 
may thereby save the life of the fetus, although not yet fully 
matured. 2. We may cause the hemorrhage to cease spontane- 
ously by permitting an involution or contraction of the uterus 
when freed from its contents. 3. We may be enabled to apply 
remedies, of a topical character, directly to the bleeding parts. 

The method of bringing about evacuation of the gravid uterus 
has already been discussed on page 428. The conditions here 
demand the greatest possible celerit}' compatible with safety, 
once the operation has been determined upon. We cannot 
readilj' bring about prompt evacuation of the uterus in the cow, 
because the cervix is .so firmly contracted, but in the mare, with 
the very dilatable os uteri, delivery can be brought about very 
quickly. 

After emptying the uterus of its contents, cold water or as- 
tringents may be injected into its cavity, or it may be packed 
thoroughly with gauze saturated with astringents, such as alum. 
Those astringents or styptics, like the persulphate or iron and 
some others which are irritant, should not be applied, because 
they tend to induce straining, which serves to cause the hemor- 
rhage to continue and defeat the practitioner's aim. 



DISEASES OF THE FETUS AND ITS MEMBRANES. 

The fetus is contained in the hermetically sealed uterine 
cavity of the mother and is further protected by the fetal en- 
velopes and fluids which surround and protect it from trauma- 
tic injuries and from thermic changes, so that it is well guarded, 
against dangers from without. The maternal system furnishes, 
through the placenta, abundant nourishment and removes by the 
same avenue, its excretions. When describing the placenta we 
noted that its structure is such that, while freely permitting the 
passage of nutrient substances, from the mother to the fetus, and 
waste products from fetus to mother, it generally serves as an 
efficient barrier against the passage of disease-producing micro- 
organisms. The fetus is thus protected upon every hand in an 
unusual degree "against disease or accident. 

Nevertheless the fetus is subject to many forms of disease and 
accident which may imperil its life or bring about changes 
which render it of little value when born. 

In the preceding pages, in tracing the development of the 
fetus, we have from time to time mentioned some aberrations in 
the development of the fetus, such as monstrosities and defects 
which more or less destroy the value of the young animal. 

Though some of these aberrations in development render the 
fetus incapable of living at the time of birth, and others have 
little danger to the life of the young animal but simply affect its 
value, none of them, as a rule, lead to death of the fetus during 
its intra-uterine life. 

On the other hand, various diseases of the fetus or of its mem- 
branes lead more or less frequently to its death and expulsion. 

Death of the Fetus. 

Death of the fetus occurs in all species of animals and at any 
stage of intra-uterine life from the beginning to the end. In the 
majority of cases, when death of the fetus occurs, it is promptly 
expelled. This we know as abortion. 

In other instances, which are far more rare, the dead fetus is 
not expelled but is retained within the uterus for a more or less 
indefinite period. The retained dead fetus may pursue a variable 
course, according to circumstances. It may undergo aseptic 
wasting or mummification. There may occur a maceration or 
460 



Munimificatio7i 



461 



softening, in which, if there is infection present, it is not accom- 
panied by the ordinary features of putrefaction. The fetus may 
undergo ordinar}' putrefactive decomposition, with the formation 
of gases. The recognized causes of fetal death are considered in 
the following chapters. 

Mummification. When a fetus dies within the uterus and 
escapes infection, its fluids and soft parts gradually become ab- 
sorbed, until finally there remains a hard, dry, blackened fetal 
mass. The skeleton is complete and perhaps normally formed, 
the skin intact and probably covered with hair, while the soft 
parts are wasted, hard and dry. See Fig. 86 and compare with 
Fig. 81. The cadaver of the fetus is usually without odor and 
has apparently escaped infection wholly. 




Fig. 86. Mummification of Fetus. Cow. 

This condition is dependent primarily upon the firm closure, 
or hermetic sealing, of the os uteri and naturally occurs with 
greatest frequency, if not wholly, in ruminants, where the long 
and narrow cervical canal is surrounded by a great abundance of 
dense and firmly contracted tissue, which holds and keeps the 
canal thoroughly closed. Among ruminants it is seen most fre- 
quently in the cow. As a general rule, death of the fetus occurs 
from the 5th to the 6th or 7th month and rarely somewhat later, 
so that the mummified fetus usually measures from 12 to 16 or 
18 inches in its greatest diameter. In rare cases it may almost 
reach the normal measurement of a fully developed calf. 

The cause of death, in cases of mummification, is not known 
and presumably varies according to circumstances. It is only 



462 Veterinary Obstetrics 

essential that the death has been brought about by some 
cause which has not been dependent upon, or accompanied by, 
an opening of the cervical canal and that no infection has 
gained access to the fetus or its membranes. 

The symptoms of death and mummification of the fetus are 
negative. No signs of disease are present. It may first be 
suspected when the animal is found to be sterile, without signs 
of estrum. While the fetus is alive there is no departure from 
the ordinary signs of pregnancy and when it perishes the event 
is not marked by any external manifestations. The signs of 
pregnancy, however, cease to accumulate : the abdomen does 
not increase further in size ; the milk glands do not continue to 
develop. On the other hand, there is no external evidence that 
the animal is not pregnant. The presence of the mummified 
fetus prevents ovulation and estrum. The cow remains quiet 
and tends to fatten. Finally she passes her normal period for 
calving and no signs of parturition, or the approach of it, appear. 
If at this period a careful examination be made per rectum, it 
will be found that the uterus contains a hard, rigid, unyielding 
mass, in which some parts of the fetus may be recognized. The 
fetal fluids have largely disappeared and the uterus closely in- 
vests the mummj'. If undisturbed, the mummy remains in- 
definitely in the uterus as a permanent source of sterility. In 
some rare cases, for reasons unknown, the mummy is expelled 
after a variable duration of time and the cow may again ovulate 
and conceive. 

In the vast majorit}' of cases the condition is not -discovered or 
suspected. The cow, remaining unfruitful for a long period of 
time and in the meantime becoming fat, is sold to the butcher, 
and upon slaughter the actual condition is discovered. 

The treatment of this condition necessarily falls under the 
head of SterilitJ^ Except as a cause of sterility, mummification of 
the fetus is without significance and does not injure in any 
way the well-being of the mother nor affect the value of her flesh 
for human food. 

When an examination is made to discover the cause of sterility 
and the presence of the mummified fetus is discovered, the only 
course to pursue is clearly that of the extraction of the fetal ca- 
daver. If it can be determined by rectal exploration that the corpus 
luteum resulting from the pregnancy still persists, it would appear, 



Maceration and DecomposUion of the Fetus 463 

according to Hess, that the expulsion of the fetus might be 
brought about by the artificial pressing out of this body, there- 
by inducing uterine contraction, which may be further favored 
by massage of the uterus per rectum. This failing, our only 
recourse is the mechanical dilation of the cervical canal and the 
extraction of the mummy. In the extraction of this unyielding 
mummy, considerable difficulty may be encountered if it is of 
very large size or when one or more of the limbs project in an 
unfavorable direction. It may be necessary to perform em- 
bryotomy. 

Maceration and Putrid Decomposition of the Fetus. 

When the fetus perishes in the uterus and the os uteri is per- 
vious and permits the entrance of micro-organisms, the fetal body 
quickly undergoes maceration or putrefaction. The exact type 
of decomposition varies in diiTerent cases. In one, it may simply 
amount to a softening and solution of the fetal body and mem- 
branes, with some fetor. In other cases putrefaction takes on the 
ordinary type, with a great fetor and the formation of large vol- 
umes of gases. When the putrefaction is rapid, so that the uter- 
ine walls can not readily and quickly expand to accommodate 
the large volume of gases, rupture of the uterus may occur. If 
the decomposition and formation of gases are not so rapid, the 
walls of the uterus become inflamed and thickened and lose their 
contractile power. There is an abundance of pus formed from 
the mucous membrane. Sometimes the cavit}' of the uterus as- 
sumes the type of an abscess which eventually opens upon the 
exterior, either directly through the abdominal walls, or indi- 
rectly through the os uteri, vagina, intestines, or rumen. When 
the disease pursues such a course, the uterine walls become ad- 
herent to that part through which the opening is to occur and 
eventually the fetus, with other putrid contents of the uterus, is 
expelled. Through the abscess opening there may enter into the 
uterine cavity particles of food from the intestinal tract. When 
the uterine abscess empties itself through the cervical canal into 
the vagina, the os uteri becomes slightly dilated and portions of 
the fetus may from time to time be expelled through this 
opening. 

The symptoms of maceration or putrefaction of the fetus are 
extremely varied. When portions of the fetus are expelled 



464 Veterinary Obstetrics 

through an abscess opening upon the surface of the abdomen, 
the diagnosis is easily reached. When the uterine contents are 
being discharged intermittently through the vagina, it is possible 
to determine the nature of the disease by examination of the ma- 
ternal organs or of the expelled parts. When the discharge of 
the fetus and uterine contents takes place through the digestive 
tract, there is usually a fetid diarrhea at the time of discharge, 
which may reveal its nature by the presence of fetal bones or 
of other fetal parts. 

When these fetal parts are not being discharged, the symptoms 
are not so clear. There is usually marked depression of the 
patient, and indications of some profound internal disease, with 
symptoms indicative of septicaemia. There is emaciation, with 
a general appearance of bad health, poor appetite, etc. 

Such symptoms are not always present, however, and in some 
cases the patient may remain apparently well while a fetus is 
rapidly decomposing in the uterine cavity and is gradually es- 
caping to the exterior through the genital canal or, more fre- 
quently, through some artificial channel. An examination per 
rectum may reveal the greatly distended and fluctuating uterus 
and even the character of its contents. The fact that an animal, 
which has been supposed to be pregnant, has passed beyond the 
normal date for parturition, and has become unwell, should- 
arouse the suspicion of the veterinarian and lead him to make a 
detailed examination. If, in addition, there have been more or 
less evident signs of labor at or near the proper time for parturi- 
tion, the symptoms become highly suggestive. 

The cause of retention and decomposition of the dead fetus is 
exceedingly variable and depends for the most part upon some 
impediment to its expulsion after death. The prevention of ex- 
pulsion depends frequently upon torsion of the uterus, especially 
in the cow and ewe, more rarely in the mare and other animals. 
In numerous cases of uterine torsion, in the ewe and cow, the 
uterus becomes transversely parted in its cervix or the vagina is 
ruptured transversely and the gravid uterus drops down upon 
the floor of the abdomen, a detached mass. The fetus decomposes, 
because infection has gained admission to the uterine cavity 
during torsion, and the detached organ serves as an asbcess cavity. 
This finally evacuates itself through the floor of the abdomen or 
through the intestinal tract. 



Maceration and Decomposition of the Fetus 465 

In other cases, the retention and decomposition of the fetus 
may depend upon induration or constriction of the cervix, upon 
mal-presentation of the fetus or some form of monstrosity pre- 
venting normal delivery. Artificial delivery at the proper time 
has been neglected or has failed. 

The treatment of retention of the fetus, accompanied by 
maceration or putrid decomposition, depends upon the removal 
of the fetus and disinfection of the diseased uterine cavity. The 
method for bringing about the removal of the uterine contents 
will depend upon the cause and will be considered under the 
various heads which may induce this condition, such as Torsion 
of the Uterus, Constriction of the Cervix Uteri, Fetal Dystokia 
and other chapters related to the causes which we have suggested. 



30 



ABORTION. STILL BIRTH. PREMATURE BIRTH 

The term abortion admits of a variable interpretation and is 
used with a different meaning by various writers and by the 
same writers in different cases. Generally speaking, we un- 
derstand abortion to mean the expulsion of the fetus from the 
uterus at such a stage of its existence that, if still living, it is 
not sufficiently developed to live. 

When a living fetus is expelled prematurely and in a state of 
development which renders survival possible, the accident is desig- 
nated premature birth. In human obstetrics it has been attempted 
to fix a given date or period in gestation which should constitute 
a dividing Hue between abortion and premature birth. This 
point cannot be definitely fixed and has in fact been changed 
somewhat recently by the introduction of incubators in human 
obstetrics for the preservation of the lives of prematurely born 
infants. It has been thereby rendered possible to save the lives 
of infants born at a stage of development which, in previous years, 
would have led to their death. 

The designation of still-birth is applied to those young which 
are expelled at an age when they are sufficiently developed that 
they might live, but have in fact perished prior to their expul- 
sion. 

Another element has entered into veterinary obstetrics which 
serves to complicate our definition of abortion. We have an in- 
fectious disease which exerts its fundamental and marked influ- 
ence upon the life of the fetus, and which we know as infectious 
abortion. In speaking of this disease, we are consequently deal- 
ing with an infection and it matters but little to us at what stage 
the fetus becomes affected with the malady or what its results 
may be. If the fetus dies in the uterus and is thereafter ex- 
pelled at any stage of gestation, the occurrence is designated 
infectious abortion, even though the expulsion of the dead fetus 
does not occur until the close of the normal period of gestation. 
If the fetus is expelled alive, even though it has reached such a 
period of development that, under normal conditions, it might 
live, but, under the influence of the infection acquired within the 
uterus, succumbs early to the malady, we designate it infectious 
466 



sporadic or Accidental Abortio?i 467 

abortion. Even if the fetus should become infected late in ges- 
tation, be born alive and comparatively vigorous though suffer- 
ing from the infection acquired while in the uterus, and finally 
overcome the effects of the disease and live, we should still speak 
of it as infectious abortion. Thus, in speaking of abortion in 
domestic animals, we include a variety of conditions, which it is 
difBcult to include under one definition. 

We recognize three classes of abortion in domestic animals : 

1. Sporadic or accidental abortion, in which, owing to disease 
of, or accident to, the fetus or mother, the fetus may be expelled 
dead or in a state of disease which renders it impossible for it to 
live. 

2. Enzootic abortion, due to some infectious disease of the 
mother, which brings about the death and expulsion of the fetus 
as a complication of the maternal disease. 

3. Infectious abortion — an infection of the fetus and its mem- 
branes which causes the death and expulsion of the fetus or its 
expulsion in a living and enfeebled state at any period of gesta- 
tion from the date of conception to the normal completion of 
pregnancy, without directly inducing material evidence of dis- 
ease in the mother. 

I. Sporadic or Accidental Abortion. 

Any disease of the mother may more or less remotely involve 
the well-being and safety of the fetus and may bring about its 
death. Some infectious diseases cause the death of a large per- 
centage of fetuses. These we shall consider under enzootic abor- 
tion. Clinically, illness of the pregnant female does not as a 
rule seriously imperil the life of the fetus. Animals in various 
stages of gestation, suffering from high fevers and a great variety 
of disorders, if they recover, usually carry the fetus safely. 

Painful diseases of the digestive canal, accompanied by severe 
tympany with exalted intra-abdominal pressure, may bring about 
abortion, but in the vast majority of cases do not do so. 

The toxic effects of various drugs, especially of those, which 
have some special effect upon the genito-urinary organs, are 
claimed to sometimes produce abortion. But we do not as a rule 
observe such effects from these drugs. Harms asserts that he has 
frequently administered aloes to pregnant mares without observ- 
ing ill-effects, but that, when he gave an aloetic purge to a mare 



468 Veteri?iary Obstetrics 

which was suckling a foal, the latter died from superpurgation as 
the result of partaking of too great an amount of aloes in the milk 
of its mother. Harms had warned the owner against permit- 
ting the foal to suck the mare, but he milked her and fed the 
milk to the foal. 

Foods of various kinds have been accused of producing abor- 
tion, but the basis for the charge is not very clear. It is ex- 
ceedingly difficult to- determine the facts in these allegations, be- 
cause many of them go back to a period when the infectiousness of 
diseases in general was doubted and when various influences 
were invoked to account for the prevalence of a disease. In 
fact, that era of doubt has not yet wholly disappeared and per- 
haps never will. We find among laymen a strong tendency to 
doubt the infectiousness of abortion. Instead the3' invoke vari- 
ous theories to account for the di.sease. Even among veterinari- 
ans, we find doubters and skeptics in relation to infectious dis- 
eases, who must find some explanation for the appearance of the 
disease, other than infection. In the literature of earlier days, 
we find prominent mention of the injurious effects upon the 
fetus of fodder which has been more or less spoiled by rust or 
moulds of various kinds, and especially those fodders which 
have been affected with smut and ergot. These charges cannot 
well be traced to a definite and reliable source. Harms relates 
that he has seen ergot given to pregnant cows in very large 
quantities, without effect, and that in one case he killed a preg- 
nant goat with ergot without producing any signs of abortion. 
We have been unable to find any definite records, in veterinary 
literature, where ergot or any other drug has caused abortion 
without first seriously jeopardizing the life of the mother. 

We believe, therefore, that, while there may occasionally oc- 
cur an abortion from the improper feeding of the pregnant ani- 
mal, the losses from this cause have been greatly exaggerated 
and are not especially important. We would not be understood, 
however, as suggesting carelessness in the feeding of pregnant 
animals, but merely as insisting that the safety of the mother 
and fetus are bound up together in so far as diet is concerned 
and that whatever food may be healthful for the one is compara- 
tively safe for the other. It is needless to advise against the 
use of mouldy, rustj' or ergotized food for pregnant females, 



sporadic or Accidental Abortio7i 469 

because of the same cousideratioiis which lead us to advise 
against it for non-pregnant animals. 

The low temperature of food or water has been invoked to ex- 
plain some cases of abortion. In our observation, however, the 
ingestion of cold food or water acts injuriously only under ex- 
ceptional circumstances. Harms asserts that large quantities of 
frozen food may bring about abortion and we may well believe 
this because it may produce very severe indigestion and toxaemia. 
So it is claimed that injection of cold water into the vagina may 
bring about labor pains and the expulsion of the fetus, and also 
that the drinking of a large amount of very cold water will pro- 
duce the accident. There is another phase of the question 
which should be considered. In piany parts of the country 
pregnant animals habitually drink ice-cold water during the 
winter months ; they constantly eat food which is out of doors 
and in many cases has a temperature considerably below zero ; 
they dig away snow from grass in order that they may eat it and 
many of them depend upon snow for the'r water supply. Yet, 
abortion does not occur in such animals. If, however, a preg- 
nant mare is driven until very warm and fatigued, and then 
allowed to drink a large volume of ice-cold water, we may well 
believe that serious results to the fetus may occur. If pregnant 
cows are kept in a warm stable until they have become exceed- 
ingly thirsty and are then allowed to drink heavily of cold water, 
a severe shock to the fetus, as well as to the mother, may occur. 

Habit apparently has a strong influence in the production of 
abortion in individual animals, or possibly we might say that in 
the individual herself there exists some peculiarity, some 
weakness or defect of the genital or of the general system, which 
tends to prevent a fetus from arriving at full maturity and leads 
to its premature death and expulsion. Such instances are fre- 
quently noted in woman and are not rare in the mare and cow, 
but the exact reasons therefor are not well understood. 

Twin pregnancy in the mare generally leads to abortion at 
about the 8th to roth month of gestation. Probably 90% of 
twin pregnancies in the mare thus end in the death of both 
fetuses. In many twin pregnancies in the mare, the two fetuses 
die at different periods but are expelled at the same rime, the two 
showing different stages of development. The reasons for abor- 
tion, in case of twin pregnancy in the mare, are not understood. 



470 Veterinary Obstetrics 

It may be that the two fetuses in some way cause mechanical 
injuries to each other during movements' of the mare and thus 
induce some injury to the placenta and lead to fetal death. 

Psychic influences are claimed by some to induce abortion in 
rare cases. Cases have been related where mares have aborted 
immediately after suffering greatly from fright, but even here it 
may be that some physical injury resulted because of the fright. 
It has been stated by various writers that, if one animal in a 
stable aborts, the sight of the accident may cause neighboring 
females to also abort. Harms very properly remarks that, if 
such a view were correct, an animal giving birth to young at the 
regular time in the presence of other pregnant females should 
cause them to abort. So fat as our literature indicates, it would 
seem that psychic influences play a very small part in the 
problem of abortion. I,arge herds of cows, ewes, mares and 
sows are permitted to regularly give birth to their young in the 
presence of the other pregnant animals, without visible danger 
of inducing abortion or premature birth. Simultaneous births 
in a herd may usually be regarded as coincident rather than con- 
sequent. 

The castration of pregnant females usually causes abortion, 
although such a result is not inevitable. The danger of abortion 
following castration is sufficient to contra-indicate the operation 
in pregnant animals where it is probable that the accident would 
imperil the life of the mother. In some animals, like the bitch, 
we habitually remove the fetus and uterus at the time of castra- 
tion, so that the question of possible abortion does not concern us. 

Mechanical irritations of the os uteri and vagina are said to 
endanger the life of the fetus, but we have insufficient data to 
clearly indicate the degree of risk. In practice we ordinarily 
make manual explorations of the vagina, in our larger pregnant 
animals, without any apparent danger. We recall one case in 
which the owner of a valuable brood mare examined her per 
vaginam because he believed she was not in foal. He dilated 
the cervical canal and discovered the fetus, which he mistook for 
a tumor. Later I was called and found the fetus, about 12 inches 
long, still alive. Soon after this examination, the mare aborted. 
This, however, does not show that examination of the vagina in 
pregnant mares is dangerous, but merely that when the hand is 
passed beyond into the uterus, where it eventually disturbs the 



sporadic or Accidental Abortion 471 

union between the fetal membranes and the uterus, and causes 
infection, abortion is probable, if not inevitable. Perhaps it is 
through some such examinations that the manipulations of these 
parts have acquired the reputation of being highly dangerous. 
It is evident that, if we need make manual exploration of the 
vaginse of pregnant animals, we should do so with judgment and 
be careful not to cause unnecessary disturbance. 

Since severe hemorrhage of the mother tends to produce fatal 
collapse of the fetus and is considered at times to cause abortion, 
it is well that animals which are advanced in pregnancy should 
not be submitted to operations accompanied by extensive loss 
of blood. 

Mechanical insults probably play a highly important part in. 
the production of accidental abortion. They may act in a 
comparativel3^ direct manner upon the fetus as when some vitaL 
portion of its body is lying in close contact with the abdom^ 
inal wall and receives a powerful blow from outside. More 
commonly, mechanical injuries have their effect somewhat in- 
directly by disturbing the connection between the fetal mem- 
branes and uterus. Anything which can cause a separation be- 
tween the maternal and fetal placenta tends to imperil the life of 
the fetus. If the separation is comparatively slight, hemorrhage 
occurs between the chorion and uterus, especiallj' in animals 
with diffused placenta, as the mare. The extension of this de- 
tachment over a very wide area tends finally to cut off the blood 
supply to the fetus and to induce uterine contractions, with 
expulsion of its contents. If an animal well advanced in preg- 
nancy falls violently, becomes cast in the harness or stall, or be- 
comes mired, the violence of her movements may cause a de- 
tachment between the chorion and uterus and lead to the death 
and expulsion of the fetus. 

The jamming and jolting suffered by pregnant animals during 
transportation by rail, and severe draft, is liable to bring about 
injuries which may lead to abortion. When pregnant mares are 
put to work where the draft is very heavy, or especially where 
it is intermittent or jerky, the danger of injurj^ to the young is- 
sometimes very great. Mechanical injuries are possible at any 
time, at work or play. 

In dairies where the cows are kept in uncomfortable stanchions,. 



472 Veterinary Obstetrics 

on slippery, wet floors, there may at anj' time occur a slip or 
fall which may imperil the life of the fetus. 

Mechanical injuries leading to abortion are more common in 
uniparous animals, because in these the uterus is more fixed in 
its position and does not yield so readily to external forces. 
Moreover, it is in these animals that we most frequently observe 
injuries, either at work or in transport, as they offer greater 
difficulty in handling. When they fall, their greater height and 
weight increases the impact and intensifies the strain upon the 
placental attachments. The greater size and weight of the fetus 
concentrates its impact upon a comparatively small area and in- 
creases the injury to the placenta. 

The recognition of an impending abortion is usually difficult 
until near its completion. Usually the abortion occurs before 
the owner or caretaker has become aware that it is threatened, 
so that the first evidence which is observed is the fact that the 
abortion has taken place, as is shown by the presence of the 
expelled fetus and membranes. In cases where a number of 
pregnant females are kept together, it may even be difficult to 
determine which one has aborted, except there can be found 
some marks upon the animal, consisting usually of soiled tail, 
perineum and thighs, due to blood and fetal fluids discharged 
from the genital canal. 

In other cases the threatened abortion is indicated by swelling 
of the vulva and a muco-puruleut discharge, accompanied some- 
times by swelling of the udder. The s}'mptoms increase general- 
\y as the duration of pregnancy increases, so that when a late 
period of pregnancy has been reached the symptoms are similar 
to those of normal birth. Rarely the expulsion of the fetus 
does not occur until some time after its death and there 
may be swelling of the udder, with secretion of milk, for days- 
or weeks before the fetus is finally expelled. Sometimes in the 
mare, there is observed swelling of the udder and secretion of 
milk without apparent cause, which continues for several days 
and finally disappears. Later, in the course of some weeks, the 
mare aborts twins, one of which is found to be much less de- 
veloped than the other. This suggests that the one had perished 
at the time when the swelling of the udder was noted, but had 
not been ejfpelled, and the other had continued to live and grow 



Enzootic Abortion 473 

until finally it too perished and the two were then expelled to- 
gether, in different stages of development. 

The course of abortion is generally rapid and when once be- 
gun is usually completed quickly, offering little or no hope that 
it may be in any way averted. If the os uteri is still closed and 
there are simply some feeble labor pains, it is barely possible that, 
by quieting the animal, the normal duration of pregnancy may be 
reached and living young produced. Such a result is almost 
unknown clinically. 

Harms suggests that we may check the labor pains by the in- 
ternal administration of camphor, with opium, alcohol or other 
stimulants. 

When abortion has actually occurred, it is not possible to at 
once determine if it is sporadic or infectious and consequently 
we should treat each case of abortion occurring in a stable or 
herd as suspicious of infection and handle it accordingly. This 
will be considered under Infectious Abortion. 

The sequelae of the sporadic abortion are the same as those of 
the infectious kind, which will also be considered in that chapter. 

II. Enzootic Abortion Resulting from Infectious Dis- 
eases OF THE Pregnant Animal. 

When considering contagious cellulitis, on page 68, we noted that 
nearly all pregnant mares suffering from this affection aborted. 
When describing venereal diseases, on page 73, we laid stress upon 
the frequency of abortion in certain of these maladies, especially in 
the granular venereal disease of cows and dourine of mares, in 
which affections a large proportion of the pregnant animals abort. 
In some other infectious diseases of animals, abortion is common. 
It occurs frequently in foot-and-mouth disease and contagious 
pleuro-pneumonia of cows. In sheep-pox, abortion is said to be 
frequent. Pregnant sows suffering from hog-cholera generally 
abort. 

The reason for abortion in these affections is not well known. 
As the micro-organism which causes some of these diseases is not 
fully determined or its nature is in dispute, it is impossible to say 
whether the fetus contains the causative agent or not. It is 
quite possible that the death of the fetus, in many of these in- 
stances, is due to the passage, into the fetal circulation, of the 
toxic products of the malady. It is clearly possible that the 



474 Veterinary Obstetrics 

micro-organism of the disease itself may pass through the pla- 
cental capillaries and gain entrance into the fetal circulation, 
thus accomplishing its destruction. 

So far as known at present, the micro-organisms of those in- 
fectious diseases which frequently cause abortion in the preg- 
nant female largely belong to the assumed ultra-microscopic 
group. The causative agent can pass through an ordinary filter^ 
and perhaps also through the dividing membrane between the 
placental blood-streams of mother axid fetus. Among the dis- 
eases mentioned as causing abortion, dourine constitutes an ap- 
parent exception, the disease being clearly due to the presence 
of a trypanosome. But we do not know that it causes abortion. 
It prevents breeding certainly enough, but whether it inhibits 
fertilization in the affected mares or later destroys the young em- 
bryo is not ascertained. Even in the latter case the para.site ea- 
ters by the genital canal, is known to exist in the genital secre- 
tions and can directly attack the fetal membranes. 

The symptoms of abortion from such diseases present no differ- 
ences from those of accidental abortion and can only be differen- 
tiated from such by the fact that the abortion occurs in imme- 
diate connection with the contagious fever itself and independent 
of anj' other known influence which could bring it about. 

This form of abortion is important because the loss to the 
breeder is the same as in other abortions, with the additional 
danger that, b5' complicating the disease of the mother, it in- 
creases the mortality among pregnant females. 

There is nothing to be done in the way of prophylaxis or con- 
trol of such outbreaks of abortion, aside from the general meas- 
ures to be taken in reference to the contagious disease of the 
mother. In this connection it might be well to emphasize what 
we have already said on page 68 in reference to contagious cel- 
lulitis, which, because of this tendency to abortion, constitutes 
one of the most dangerous diseases of stallions and brood mares. 

III. Infectious Abortion. 

The vast majority of abortions in domestic animals are due ta 
infection. The disease is most common in the mare and cow and 
has been observed in the ewe, goat and sow. 

According to many authors, abortion is most common and 



Infectious Abortion 475 

serious in the cow, but it is questionable if this is correct in all 
respects. The loss from single abortion is generally greater in 
the mare than in the cow. A large proportion of calves are 
destroyed at once or .soon after birth because they are virtually 
worthless or their raising entails more expense than their ulti- 
mate value when grown. The principal lo,ss in the cow is the 
interference with the milk yield, which is of course highly im- 
portant. In the case of the brood mare, it is desired to raise 
each foal and its death becomes a serious loss. Compared with 
the calf, its individual value is much greater. 

Therefore, when abortion becomes widespread in a region 
where horse breeding is very extensive and where the animals 
have a high value, the losses are enormous and it is difficult to 
state, without reliable statistics, in which .species of animal 
abortion causes the greatest monetary los.ses, although we must 
admit that the economic loss from abortion in cows has received 
more attention and is more apparent. The view is doubtle.ss 
correct that abortion in cows is more widespread, largely owing 
to the fact that the infection apparently has a better opportunity 
for spreading. The disease in cows also has better opportunity 
for perpetuation owing to the fact that cows are bred through- 
out the entire year, whereas, in the mare, the breeding is more 
concentrated at one season, and an outbreak of abortion may 
vent its full force by destroying all the fetuses in a stable and 
then cease to exi.st for want of material to sustain it. 

Most authors consider infectious abortion as a universal mal- 
ady which may be transferred from one species of animal to an- 
other. A few cases have been cited, in our literature, where in- 
fectious abortion has prevailed simultaneously on the same farm 
among cows and mares, but this is a very rare occurrence and 
quite contrary to the rule. Infectious abortion occurring in dif- 
ferent species of animals simultaneously upon the same farm is 
no more frequent than should be expected as a coincidence. 
There is no reason why infectious abortion of mares and cows 
may not co-exist as two distinct affections on one farm. In our 
earlier experience, we observed chiefly infectious abortion of the 
mare and, in our territory, the different species of pregnant ani- 
mals largely occupied the same enclosures. 

The abortions in the mare, in our experience, very largely 
occurred in the open pasture or field. Though there were habit- 



476 Veterinary Obstetrics 

ually pregnant cows in the same enclosures, we never observed 
abortion in these. In fact, during a period of 12 years in private 
practice, in a region devoted almost equally to the rearing of 
draft horses and beef cattle, we did not observe a single outbreak 
of infectious abortion in cows. On the other hand, numerous 
outbreaks of infectious abortion of mares occurred, which were 
widespread and caused an almost total loss of the foal crop. 
During these outbreaks of contagious abortion in mares, it also 
occurred verj' naturally that the aborted fetuses and afterbirths 
were very frequently eaten by pregnant sows. Yet, we did not 
observe that any of them ever aborted from this cause. Nor 
have we ever seen infectious abortion in the sow, although in 
the region of our practice swine breeding was one of the leading 
industries and many farmers habitually bred from 10 to 20 or 
more sows each year. From a clinical standpoint, it seems very 
certain that each of our herbivorous domestic animals has a form 
of infectious abortion peculiar to itself and not transmissible in a 
natural way to other species. 

Bang (Journal of Comparative Pathology and Therapeutics, 
Vol. 19, page 191) holds that abortion among mares may be due 
to the same bacillus or micro-organism as that which causes the 
disease in cows and concludes that it ' ' reminds us not to neglect 
precautions in order to protect mares against infection from 
aborting cows." Bang has by no means proven his suspicion, 
as he failed in his one recorded experiment with a mare to pro- 
duce abortion, and the animal gave birth to a small living foal 
which continued to live for two days. He asserts, however, 
that he has produced abortion by the injection of his abortion 
bacillus into the veins of sheep, goats and rabbits, in addition to 
the cow. He has not shown, however, that any of these ever 
contracted the disease, in a natural way, from another species of 
animal. 

Ostertag (Monatshefte fur Praktische Tierheilkunde, Vol. 12, 
page 385) records a careful study of infectious abortion in the 
mare, in which he concludes that the cause of the disease in this 
animal is different from that in the cow. He finds that the 
micro-organism of infectious abortion of the mare is a short 
streptococcus, instead of a bacillus, as described by Bang and 
others as the cause of abortion in cows. 



Infectious Abortioji of Mares 477 

Ostertag produced further evidence of the non-identity of in- 
fectious abortion, in various species, by experiment. He inocu- 
lated two pregnant goats with the membranes of foals which had 
been expelled as a result of infectious abortion, and each of them 
gave birth to living and vigorous kids. He further attempted ex- 
perimental inoculation in four pregnant mares and ten pregnant 
cows, with the result that two of the mares aborted, the one after 
8 days and the other after 20 days. Each fetus contained the 
cocci of abortion. The other two mares gave birth to living 
foals after 8 and 17 days respectively. The foals were weak and 
the chorion of each contained abortion cocci. The foal expelled 
on the 8th day after inoculation died soon after birth, while the 
other recovered and developed normally. 

The ten experimental cows resisted the inoculation completely. 
Neither the introduction of portions of afterbirth or fetal fluids 
into the vaginse of pregnant cows from aborted foals, nor the 
inoculation of them with abortion cocci induced abortion. 

Whether we examine the question in the light of clinical ex- 
perience, bacteriologic study or inoculation experiments, it 
appears certain that the infectious abortion of one species of ani- 
mal is fundamentally and essentially different from that of an- 
other and that there is no probability of the disease spreading 
from one species of animal to another, in a natural way. Even 
by artificial inoculation, there is little to indicate that the disease, 
as such, can be transferred from one species to another. 

We shall, therefore, deal with infectious abortion as a separate 
malady foe each of our domestic animals, although granting that 
there may be a more or less intimate relationship existing be- 
tween them, but not of a sufficient degree to render an outbreak 
of abortion in one species dangerous for other species which may 
come in close contact with the affected animals. 

A. Infectious Abortion of Mares. 

Fleming (Animal Plagues) records the occurrence of abortion 
prior to the Christian era, though definite records of the disease 
were not made to any great extent until late in the i8th century. 
As with all other infectious diseases, there was much doubt as to 
the infectious character of the .malady until after the middle of 
the 19th century, when a large proportion of the foremost veter- 



478 Veteri?iary Obstetrics 

inarians began to hold that the prevalence of the disease was due 
to infection and not to climatic or other chance influences acting 
upon a great number of animals, in the same way, at the same 
time. 

Infectious abortion of mares first acquired prominence in the 
United States about 1886, when it appeared in several states in 
the Mississippi Valley, in which horse breeding had become a 
very important industry. It soon acquired a very extensive dis- 
tribution and high degree of virulence. The unorganized state 
of veterinary science in the United States prevented the recording 
of any definite statistics in reference to the losses, but they were 
certainly enormous. At the time of the introduction of this dis- 
ease, or rather when it acquired general importance, the writer 
was in private practice at Bloomington, 111., which was then one 
of the richest draft horse breeding districts in America, and we 
estimated that in 1888, in one county, at least 2500 foals perished 
from infectious abortion. Since these foals were generally valued 
at about $60 per head at weaning time, the monetary loss maj^ 
be estimated at 11150,000 in a single year in one county. That 
county was in no way essentially different from others through- 
out a number of states. 

Were reliable statistics as to the actual losses available, they 
would be so enormous for the entire Mississippi Valley as to be 
astounding. In some townships where horse breeding constituted 
one of the principal agricultural pursuits, the abortions exceeded 
seventy-five per cent of the pregnant mares. The losses were 
most marked in large breeding establishments where highly 
valuable mares were kept for breeding purposes alone. The 
losses were just as real on small farms where but a few mares 
were kept, which, after aborting, could be employed to some 
extent in farm work. However, throughout this area, many 
farmers maintained a number of mares wholly for the purpose of 
breeding. In such herds, the losses of the foal crop were often 
complete. In one season, one of our clients with a highly valu- 
able herd of imported draft mares, about 50 in number, lost every 
foal from infectious abortion, save in the case of one mare, which 
was in our hospital under treatment for a chronic disease and 
consequently carried her foal to full term. In another instance, 
in the territory of a neighboring veterinarian, a breeder had 100 
pregnant imported draft mares, in which the loss from infectious 



Infectious Abortion of Mares 479 

abortion was total as to foals, and four of the mares perished be- 
cause of sequelae. Other similar instances might be related 
without number and give a somewhat vivid impression of the 
enormous losses which may be caused by this malady. 

The infectiousness of the disease is shown by clinical obser- 
vation. In a large proportion of cases it is possible to trace the 
beginning of an outbreak of abortion in a herd of mares to the 
temporary or permanent indroduction of a mare from a herd in 
which the malady already existed. A pregnant mare is bought 
from an infected herd and placed in the stable or pasture with 
pregnant mares, which, up to the time, were free from the 
disease. Within a few days abortion sets in and nearly or all 
the pregnant mares in the herd abort as a result. In other cases, 
a neighbor has driven a pregnant mare, or one which has re- 
cently aborted, from his own farm to that of his neighbor and has 
placed it in close proximity to the pregnant mares or has tempora- 
rily placed it in the stable, and even in the same stall where preg- 
nant mares are later brought. Within a few days, these mares 
in turn commenced to abort. Or, the owner of a number of 
pregnant mares drives one of them to a neighbor's or to a public 
stable where animals afflicted with the disea.se have been kept. 
Returning home, this mare soon aborts. After an interval, other 
abortions follow and finally destruction of the entire foal crop. 

Guillerey (Archiv fur Tierheilkunde, Vol. 29, page 37) gives 
us some excellent data of the way in which an outbreak of 
abortion in mares spread in his territor)'. G. was called on 
January 27, 1897 to remove the afterbirth from a six year-old 
mare which had aborted at 10 months the previous evening. As 
the mare was unable to expel the fetus without assistance, the 
owner asked four neighbors to assist him. Three days later, in- 
fectious abortion of a virulent character broke out in the stables 
of each of these four friends. On the 4th of February, in the 
same locality, two mares owned by P. aborted. Three days 
previously P. had assisted a neighbor in a case of difficult labor 
from abortion. In another case he records that a mare aborted, 
and that neighbors who entered the stable conveyed the in- 
fection to their own animals, which, in turn, aborted. Following 
the entire outbreak, G. was able to trace the source of infection 
with uniformity from stable to stable and from village to village. 



480 Veterinary Obstetrics 

In two small villages, where there were 68 pregnant mares, 60 
of them aborted. 

An extensive array of clinical observations as to the infectious- 
ness of the disease might be added. They all have the same 
general character and force. The disease does not occur except 
as a result of exposure to some animal, either directly or indirect- 
ly, which has previously aborted, and when this exposure does 
take place abortion is as liable to follow as is the occurrence of 
any other contagious disease known to veterinary science. 

Experimentation affords good evidence of the infectiousness 
of abortion in the mare. Ostertag, as already related, records 
four cases, with abortion in two of the animals and suggestive 
results in the other two. 

Guillerey cites one experiment, which in itself is admittedly 
inconclusive. A piece of afterbirth from a mare which had 
aborted was introduced into the vagina of a mare in the 9th 
month of gestation. Two days later there was a muco-purulent 
discharge and on the 3rd da)- the mare aborted. Here and there 
in veterinary literature, occasional cases are mentioned where 
mares have been caused to abort by experimental inoculation, 
but the number of these is not extensive. So far as these ex- 
periments have been carried, they are strongly indicative of the 
infectious character of the disease. 

The bacteriologic researches of Ostertag and others furnish 
additional proof of the infectious character of the disease. 
Ostertag separated and cultivated a short streptococcus, which 
produced abortion after experimental inoculation. The micro- 
organism was obtained in pure cultures from the aborted fetus 
and its membranes. 

We have further proof of the infectious character of the disease 
in the fact that it may be largely controlled by disinfection and 
the isolation of pregnant animals. The significance of this 
proof will be brought out in our consideration of the control of 
the disease. 

In common with the behavior of all infectious diseases, the 
contagious abortion of mares is most freq^uently seen and attains 
its greatest virulence in those regions where horse breeding is 
most concentrated and the animals have a high value. This 
involves, as a general rule, the close stabling of animals or their 
being kept in close contact with each other upon pastures. 



Infectious Abortio7i of Mares 481 

Infectious abortion in the mare may occur at any stage during 
pregnancy — an observation which possibly holds true to a great 
extent for other domestic animals. The abortion is most fre- 
quently observed, however, after the fetus has acquired con- 
siderable size, so that it is most usually noticed after the 6th to 
8th month and even more commonly during the loth and nth 
months. In some of our observations, however, the abortion 
had apparently occurred very early, although no positive proof 
of this was obtainable. In fact it is exceedingly difficult to 
obtain proof of abortion during the first few weeks of pregnancy, 
since the small embryo, with its inconspicuous membranes, may 
be expelled without attracting any attention whatever on the 
part of the owner and does not interfere in the least visible de- 
gree with the general well-being of the animal. 

In our investigations, there was one well-defined instance 
where very early abortion seemed to be well proven. An ex- 
tensive breeding farm had over 100 breeding mares, some of 
which were imported draft animals and the others highly bred 
trotting mares. They were unusually well kept, under as favor- 
able conditions as breeding animals could well be placed. The 
mares were at pasture upon good blue-grass, which was quite 
free from herbage having any suspicious character in reference 
to breeding. The mares were young and in excellent general 
health. The stallions were vigorous and well handled and had 
previously shown themselves to be regular and sure breeders. 
During one season these mares of both breeds seemed to con- 
ceive readily upon being bred, and upon being re-tried to the 
stallion they showed no signs of estrum and were apparently 
safely in foal. After they had been re-tried one, two or three 
times successfully, it was found that later they showed estrum 
and again had to be bred. The condition was very puzzling to 
the superintendent and no explanation was apparent during the 
.spring and early summer. 

Finally, in early autumn, when some of the mares had safely 
carried their foals for several months, there was occasionally 
found in the pasture a partially matured fetus. As the season 
advanced well nigh all of the few mares, which during the breed- 
ing season had constantly shown signs of being in foal, aborted, 
and the foal crop was well nigh ruined. Here it would seem that 
there was good evidence that many of these mares aborted during 
31 



482 Veterinary Obstetrics 

the first 60 days of pregnancy, but, running in pasture as they 
were, the fetuses would not be discovered, and would probably 
be picked up by scavenger animals or birds. The mares would 
show no signs of any accident having occurred, so that it was 
onlj' later, when a few fetuses had become sufiiciently large to be 
noticeable, that the true character of the interruption in breed- 
ing was discernible. 

In other instances we have noted the disease occurring during 
the late summer and early autumn, when the mares had been 
pregnant from four to six months. In these outbreaks the dis- 
ease was quite as virulent as in those outbreaks occurring during 
the nth month of gestation. Many authors claim that abortion 
in the mare is more common as gestation nears its end. This 
difference, if it exists, is not so great as it seems, because the ac- 
cident in the earlier stages of gestation is largel}' overlooked and 
passes unseen. 

The symptoms of infectious abortion in the mare depend 
verj' largely upon the stage of gestation at which the disease ap- 
pears. It passes virtually unnoticed during the earlier stages of 
pregnane}'. During the first eight weeks of gestation it is usually 
by mere chance that abortion is discovered, - In one case which 
we observed, a mare was being driven when the driver noticed 
some object protruding from the vaginia. Upon examination, 
this was found to be a fetus about 4 inches in length, enclosed in 
its membranes. Such a fetus is readily overlooked, and its ex- 
pulsion was discovered onl}^ because the animal was being driven 
at the time. Even then it might readilj' have dropped out 
upon the road without being observed at all. Later in preg- 
nane}' there may occur slight symptoms of impending abortion 
for a few hours, or possibly a day, before the expulsion of the 
fetus. These sj'mptoms consist essentially of some swelling of 
the vulva, with a more or less conspicuous muco-purulent dis- 
charge. Tater, according to the period of gestation, there may 
be more or less prominent labor pains, with light symptoms of 
colic, a few hours prior to the expulsion of the fetus. 

Even in the more advanced stages of pregnancy, however, abor- 
tion usually occurs without forewarning and the first evidence of 
anything amiss, so far as the owner observes, is finding the dead 
fetus in the stable or pasture. 



Infectious Abortio7i of Mares 483 

The course of infectious abortion in the mare is usually very 
rapid and uneventful, in close correspondence with normal par- 
turition. The fetus is quickly expelled when labor pains appear 
and, if the abortion occurs comparatively early during gestation, 
the fetus is expelled completely enclosed in its chorion. Later in 
gestation the chorion, and sometimes the amnion, ruptures as in 
normal parturition and the expulsion of the fetus is accompanied 
by more evidence of labor. The fetus does not always present 
in a normal manner, but there are frequent deviations of the head 
and limbs. In case of anterior presentation, the head is very 
likfely to be turned to one side and one or both anterior limbs 
may be more or less retained. In presenting posteriorly, the 
breech presentation is very common. These vicious presenta- 
tions are not serious obstacles to expulsion up to the 8th or gth 
mouth, but during the 10th and nth months may bring about 
light dj'stokia. However, unless gestation has been virtually com- 
pleted, the dystokia is readily overcome by the veterinarian and 
the fetus easily extracted. After its extraction, ii. cases where 
the abortion occurs late in pregnancy, there is a marked tendency 
to retention of the chorion ; whereas, as we have previously 
stated, if abortion occurs early, the fetus is probablj^ expelled in 
its chorion. 

The sequalse of abortion in the the mare are numerous and 
frequently serious in character. They depend largely upon the 
period of gestation at which the abortion occurs, as is very well 
shown by three tables which Guillerey submits in the article 
which we have quoted. In his first table, in case of an outbreak 
of infectious abortion, he relates 17 cases, each of which were 
followed by more or less serious sequelae, including the reten- 
tion of the placenta, metritis, metro-peritonitis, tendinitis, syno- 
vitis, arthritis, lympho-phlebitis, mammitis, vaginitis and para- 
plegia. Most of these cases occurred after the loth month of 
pregnancy, and the shortest duration of pregnancy was seven 
months. In his second table, where the duration of pregnancy 
varied from the fourth to the seventh month, the sequelae were 
unimportant and virtually absent, whereas, in his third table, 
where the period of gestation ranged from the seventh to the 
ninth and exceptionally the tenth month, the sequelse occupied 
a middle position between the other two tables. 



484 Veterinary Obstetrics 

The period of incubation is comparatively short, or we 
might say that it corresponds quite closely to that observed in 
most contagious diseases of animals. According to our personal 
observations, the incubation period usually ranges from 8 to 10 
days. Guillerey considers the period of incubation from 3 to 5 
days in virulent outbreaks. In the milder cases, according to 
his observations, the duration of incubation was from 10 to 18 
days. This observation is interesting in that it would appear to 
indicate that the earlier during gestation infection occurs, the 
longer the period of incubation. The observations of G. in ref- 
erence of the period of incubation do not materially conflict with 
our own. He gives, in a supplementary table, the average dura- 
tion of incubation in the mild outbreaks as 12 days and in the 
severe outbreaks as four days. 

The bacteriology of infectious abortion in mares has not been 
determined in a manner universally acceptable. Ostertag found, 
in the blood of the fetal heart, in the thoracic cavity, and in the 
intestinal tract, short streptococci which were readily stained by 
the Gram method. In serum agar, this micro-organism grew in 
very small areas scarcely visible to the naked e5'e, while in a 
stick culture it assumed the form of a thread-like colony through- 
out the length of the tube. It also grew in a serum bouillon 
and caused, after two days, a general cloudiness of the entire 
mass. Sometimes Ostertag secured pure cultures from the body 
of the aborted fetus, while from the surface of the chorion he 
obtained the same cocci in company with various bacteria. 

In one experiment Ostertag injected a pure culture of this 
streptococcus into tltfe jugular vein of a pregnant mare. Twenty 
days later the mare aborted. 

A question of the correctness of the findings of Ostertag is 
raised by the fact that he is in apparent conflict with Bang, who 
finds in the infectious abortion of the cow a short bacillus instead 
of a streptococcus. Bang even claims, as we shall dwell upon 
more particularly in the next article, that his abortion bacillus is 
capable of producing abortion in almost any pregnant animal, 
and would apparently have us believe that the contagious abor- 
tion of various animals is identical and interchangeable. As we 
have already stated, we consider that clinical evidence shows 
very clearty the non-identity^ of infectious abortion in the vari- 
ous species of animals. Nevertheless, we should expect that 



Period of Incubation 485 

the mirco-organism should be somewhat similar in the different 
species and should belong to the same genus of bacteria. We 
would compare the bacteriology of infectious abortion to that of 
tuberculosis, in which there is a very close resemblance be- 
tween the bacilli causing tuberculosis in the various species 
of animals, so much so that the differentiation between certain 
forms is somewhat in controversy, or at least has only recently 
been definitely settled. We are strongly inclined to believe that, 
if the infectious abortion of the cow is caused by a bacillus, that 
of the mare is also referable to a bacillus ; if the infectious abor- 
tion of the raare is caused by a streptococcus, as Ostertag claims, 
the corresponding disease in the cow is likewise caused by a 
streptococcus. The evidence submitted by Bang and Ostertag 
is alike good in each case, so far as it goes, nor is there anything 
definite to show that each may not be correct in his findings. 

There exists the further possibility that the eventual explana- 
tion of this apparent conflict may rest upon a similar basis to 
that of hog cholera, where it has recently been admitted, upon 
high authority, that the disease can be produced in a typical 
form without the presence of the hog cholera bacillus. This 
leads one to conclude that the hog cholera bacillus is usually 
present in hog cholera and may have some secondary relation to 
the disease or the lesions, and that the essential cause of the 
disease consists of some micro-organism which has not yet been 
discovered. It is so small that it will pass through a filter fine 
enough to remove the hog cholera bacillus, and the filtrate will pro- 
duce the typical disease in the hog without the presence of the 
hog cholera bacillus. It is best, therefore, to accept the re- 
searches of Ostertag and others as tentative, and to await further 
researches before finally accepting any conclusion as to the funda- 
mental cause of the disease. 

The Avenue of Infection. The manner in which the in- 
fection is carried from one animal to another, and the avenue by 
which the infection reaches the fetus and its membranes, are 
highly important, from the standpoint of the control of the 
disease. Of first importance is the manner by which the disease 
is introduced into a herd or .stable. According to the observa- 
tions of Guillerey, which have already been cited, the disease 
was' carried in several instances from one stable to another by 
men. Neighbors were called by a client to aid Guillerey in 



486 Veterinary Obstetrics 

extracting an aborted fetus, who, returning to their own estab- 
lishments, carried with them the germs of the disease and trans- 
mitted it to their own mares. This experience was repeated 
several times, with the uniform result that the disease was spread 
wherever the men went into other stables, after having visited 
those where the disease existed. It appears quite unnecessary 
that the visitor to an infected stable or pasture should handle the 
mare which has aborted, the after-birth or the aborted fetus, but 
he may readily carry the infection upon shoes or other portions 
of clothing which may chance to come in contact with infected 
bedding or ground. This method of distributing the disease 
seems to Guillerey one of the most important and dangerous. 
Neighbors habitually, and without thought, visit each other's 
premises and examine and handle diseased mares, and thus may 
readily carry the infection to their own or other premises, in 
such a manner that it is frequently difficult to trace. Guillerey 
also observed cases of abortion which were traceable to the use, 
upon a pregnant mare, of a blanket which had been used upon 
another mare, which had recently aborted. The blanket had be- 
come somewhat soiled by the disharges. In another case, it 
seemed to him that the disease was traceable to a harness that 
had been used upon an aborted mare and which had then been 
transferred to an uninfected pregnant mare. 

If one introduces a mare from an infected stable into a stable 
of pregnant mares, whether the new mare has recently aborted 
or soon aborts, she constitutes a certain vehicle for the transmis- 
sion of the disease into the uninfected stable. Guillerey relates 
a case in which a peasant placed his pregnant mare in the 
stable of a distant neighbor, where abortion had existed. The 
mare, in due time, aborted and constituted a new center of in- 
fection. 

When the infection has once been introduced into a stable or 
harem of mares, the spread of the disease is rapid and certain, 
although the exact method by which it comes about is not 
definitely known. It probably occurs largely from direct 
contact. The tail of the mare becomes readily and inevitably 
soiled by any discharges of the vulva and creates an excellent 
vehicle by which the infection can be transmitted to a neighbor- 
ing animal. Since mares, as a rule, come in comparatively close 
contact, where they may strike each other about the vulva with. 



The Avenue of Infection 487 

their tails, it is easy to understand how this comparatively direct 
transmission of the disease may occur. 

On the other hand, the infection may occur in a comparatively 
indirect manner, since mares in the same enclosure habitually rub 
against objects of various kinds, and thus, one after another, come 
in contact with the same object. If they use a common sleeping 
ground, the bedding, earth or herbage becomes soiled by the 
discharges from an aborted animal and the infection is obtained 
therefrom by a pregnant mare. Thus it spreads rapidly and 
freely, whether the animals are confined in clo.se proximity in 
the stable or whether they are running free in extensive pastures 
or even upon comparatively open ranges. It is not known 
whether the disease can spread through the air without an in- 
termediary bearer. 

Some investigators of the infectious abortion of cows have 
come to the conclusion that the bull plays a highly important 
part in the distribution of the disease and in the introduction of 
the infection from one stable to another. The conclusion has 
been drawn from this that the male animal in general constitutes 
an efficient bearer of the disease, although himself not affected 
by it in any visible manner. It does not seem that the stallion 
plays a very important part in the distribution of infectious abor- 
tion of the mare. The incubation of the disease is so rapid that, 
if the infection is transmitted to the mare by the stallion, it 
would appear that abortion would occur very early and would 
not be observed. It is not safe to conclude, however, that he 
does not spread the disease in some cases. 

The stallion may otherwise be an important factor in the 
spread of abortion by copulation. We do not know how long 
the micro-organism of infectious abortion may live in the vulva 
and vagina of a mare which is not pregnant or which has but 
recently been bred. It is quite possible that a stallion which 
had first served an aborted mare, and then covered a healthy one^ 
might transfer the organisms to the genital canal of the healthy 
animal, which would then act as a bearer of the disease to any 
pregnant mares with which she might soon come in contact. 

Reasoning from the observations of Guillerey, that the soiled, 
hands or shoes of persons, or the soiled blanket or harness from an 
aborted mare, can carry the disease from one stable to another, it 
might readily follow that a gelding or other horse placed in 



488 Veterinary Obstetrics 

close proximity to a mare which had recently aborted , or which 
had come in contact with soiled bedding or with the aborted 
fetus or afterbirth, might readily carry the disease and convey it 
to healthj' pregnant mares. 

The veterinary obstetrist .should not disregard the opportunities 
possessed by himself as an important bearer of infectious abor- 
tion. In attending mares for dystocia, retained placenta, metri- 
tis, etc., resulting from infectious abortion, his clothing, person, 
instruments, etc. , become soiled and only the most rigorous care 
on his part will prevent his becoming a menace to other stables 
of pregnant mares. 

As in other infectious diseases which are capable of being car- 
ried by an intermediary bearer, there is the constant possibility 
of the transmission of the disease by means of portions of the 
aborted fetus or its afterbirth being carried from one place to 
another through the agency of scavenger animals or birds — dogs, 
crows, buzzards, etc. 

The vitality of the organism and the length of time it may 
persist and be capable of infection, whether lodged upon the 
hair or other portions of an animal, upon the hands of men, upon 
harness or blankets, we have no data to show. Neither do we 
know for how long a time the germs may remain inactive in 
the vagina and uterus of the mare and be capable of transmitting 
the disease. The impression seems to be that, after a mare has 
aborted, the organism continues virile at least as long as there is 
a discharge from the genital apparatus.' It would not be safe to 
conclude, however, that the micro-organism disappears as soon 
as the discharge ceases, but rather that it may remain in a com- 
paratively inactive state in the vagina for weeks, or possibly 
months. 

Control and Eradication. The control of infectious abor- 
tion in the mare, as in other animals, is a complex problem. One 
of the chief obstacles in the control of infectious abortion, as in 
other transmissable diseases, is the difficulty of reaching an early 
diagnosis. At present we can not always positivelj^ differentiate 
the infectious abortion from the accidental abortion of class I or 
the enzootic disease of class II. Accidental abortion may have a 
definite history of accident and a reliable record of non-exposure. 
Unless these data are very positive, little dependence should be 
placed in them. Enzootic abortion due to infectious disease of 



Control and Eradication 4^9 

the mother may be differentiated from infectious abortion proper 
by the symptoms in the pregnant mare. 

It has been claimed that infectious abortion can be differenti- 
ated from other types by the dark, dirty, grayish or brownish 
color of the chorion and the abundant dirty exudate upon its 
surface. If a fetus, dead from other causes, remains in the uterus 
until decomposition of the membranes begins, we know of no 
good reason why the appearances might not be the same as those 
described as characteristic of the infectious disease. Bacterio- 
logic differentiation is not yet available. 

When an abortion occurs in a stable, unless it can clearly and 
safely be attributed to other causes, a tenative diagnosis of in- 
fectious abortion should be made and the case handled accordingly. 

It is very difficult to prevent the introduction of the disease 
into a stable of pregnant mares, when the malady is prevalent in 
a neighborhood. When abortion among mares exists upon a 
farm during a season of the year when the animals are habitually 
out in the fields, and the aborting mares are separated from the 
healthy ones of an adjoining farm simply by a fence, the trans- 
mission of the disease from the one farm to the other is well-nigh 
inevitable and can only be guarded against by providing a neutral 
territory between the infected and the non-infected mares. 

It is also essential that owners of pregnant mares should guard 
them zealously against infection through the introduction of 
mares from stables where the disea.se exi.sts. If it becomes neces- 
sary or advisable to purchase new mares and bring them upon 
the farm, and it is not certain that they are free from the infec- 
tion, they should be isolated for an ample period of time before 
allowing them to come in contact with the pregnant animals. 
If any well-grounded suspicion of the animal exists, she should 
be thoroughly disinfected, perhaps even subjected to a bath in 
disinfectants, which would include the entire body, and a special 
disinfection of the vulva and vagina. 

It is highly dangerous, when abortion is disseminated over a 
territory, to permit outside animals to come into the stable or 
enclosure where pregnant animals are kept. We have known 
instances where a mare, which had recently aborted, was driven 
into the barn-yard of a neighboring farm where the disease did 
not exist, and, although the stay of the infected mare was of short 



490- Veterinary Obstetrics 

duration, the disease was nevertheless carried and an outbreak of 
abortion resulted. 

When the owner of a stable of healthy mares, drives one of 
them into an enclosure or places her in a stable where the disease 
exists, the mare may become infected and spread the malady to 
other animals upon the farm. In one outbreak observed by us, 
(American Veterinary Review, Vol. 21, page 303) an outbreak of 
infectious abortion in mares was apparently brought about in this 
way. The owner had a band of some 25 presumably pregnant 
mares, which were mostly highly valuable trotting animals, but 
included one grade draft mare, which was used for general work 
and was driven here and there to various farms without an3' par- 
ticular thought of harm. Somewhere in the course of her work, 
apparently, she became infected, aborted and transmitted the 
disease to the other mares upon the farm, leading to quite serious 
losses, although the course of the disease was fortunately arrested 
before the loss of foals was complete. 

The owner of pregnant mares will always do well to guard 
them cautiously against infection which may be carried by per- 
sons upon their clothing, hands or shoes. Neighbors coming 
from farms where the disease exists should on no- account be 
permitted in the stable, barnyards or fields where the pregnant 
mares are kept. The owner of pregnant mares should also be 
careful, in reference to his own person, that he does not come 
into stables or enclosures where abortion exists. 

Probably one of the most dangerous bearers of the infectious 
abortion of mares is the ignorant or careless veterinarian. We 
have already related that dystokia is common in abortion, 
occurring near the end of gestation ; various sequelae also occur 
after abortion, which cause the veterinarian to be called in 
attendance. 

In these cases the obstetrist necessarily gets his person, clothing 
and instruments soiled with the contagion, and by either of these 
agencies may be the carrier of the disease from one stable or band 
of mares to another. The veterinary obstetrist here assumes a 
profound responsibility and should take every precaution known 
to modern medicine to avoid the transmission of so serious a 
malady to animals belonging to other clients. He should not 
make a second call, under any conditions or circumstances, until 
his clothing has been changed and his person has been ampljr 



Control and Eradication 491 

and safely disinfected. Any instruments or appartus which he 
has used about an aborted animal should be most scrupulously and 
thoroughly disinfected or sterilized. Ropes, cords and other 
cheap apparatus used in cases of dystokia should not be used 
again, but should be destroyed. All clothing worn by the ob- 
stetrist should be of a character which will admit of thorough 
boiling without injury, and this should always be done before it 
is used again. Even the case, bag or other container in which 
the veterinarian transports his instruments, clothing, etc., when 
attending cases of this kind, should be of a character which will 
admit of the most scrupulous disinfection. 

When the malady has appeared in a stable or herd of mares, 
energetic measures should be instituted for its eradication. The 
following points should be included in any plan : 

I. Immediately destroy, by burning, the aborted fetus and 
fetal membranes. It is essential that this be carefully and com- 
pletely done, in such a manner as to eliminate all danger of in- 
fection from this source. If the fetus or its membranes be 
dragged, or carried dripping, over a path where pregnant mares 
may pass, they may get the infection from the infected path as 
well as from the fetus. Other animals, or persons, crossing the 
infected path may pick up and carry the infection to pregnant 
mares. A vehicle used for carrying away the fetus may serve to 
bear the infection to pregnant animals. The persons engaged in 
removing and destroying the fetus may be more dangerous than 
the aborted fetus it.self. 

Every detail in the process of the destruction of the fetus and 
its membranes should be carefully watched and, at every point of 
possible infection, disinfection thoroughly applied. 

- 2. The mare which has aborted should be at once removed 
from the stable occupied by other pregnant mares and effectively 
isolated. Even then, it is important to terminate the infection 
as early as possible, so that the mare which has aborted may no 
longer serve as a possible center of contagion. 

Internally, the uterus, vagina and vulva are to be thoroughly 
disinfected by irrigating the uterine cavity with a warm disin- 
fecting fluid. For this purpose, 2% lysol or carbolic acid or a i 
to 2500 solution of corrosive sublimate may be employed. The 
disinfection should be repeated once daily for three or more days, 
and longer should vaginal discharges be present. 



492 Veterinary Obstetrics 

The exterior of the mare which has aborted should also be 
thoroughly disinfected. Special attention should be given to 
the tail, perineum, buttocks and posterior limbs. These parts at 
least should be thoroughly scrubbed with soap and hot water, to 
which has been added 2 or 3% of lysol or carbolic acid. Cor- 
rosive sublimate is inefficient here, as it is precipitated by most 
soaps and does not penetrate the hairy coats of the animal in an 
efficient manner. 

Generally speaking, we regard the somewhat opposite plan of 
removing the pregnant mares from the infected stable as ill 
advised. When infectious abortion has occurred in a stable 
where other pregnant mares are kept, it is fair to assume that 
some of them have become infected. If removed to another 
stable, they too will abort and the other stable will also become 
infected. If the disinfection is complete, the stable in which the 
abortion has occurred is as safe as any. 

3. Remove all bedding from the stall where the mare has 
aborted, burn it or otherwi.se render it safe, and thoroughly dis- 
infect the stall. The general rules of the preceding paragraph, 
relative to the disposal of the fetus and its membranes, should 
also be applied to the bedding and manure from the infected 
stall. It must, on no account, be dribbled here and there, to 
scatter the infection ; the undisinfected vehicle used for carrying 
it must not be placed where pregnant mares vaa^y come about it. 
If it is decided to preserve the value of the manure, it must be 
placed where pregnant mares cannot come in contact with it for 
two or three months. 

The disinfection of the stall should be complete. The straw, 
chaff or bedding should not be swept out in a manner to cause 
dust to fly in ever}^ direction, but anj' dust}' material should first 
be moistened, preferabl}' with a disinfectant or with boiling 
water, then removed carefully, and the stall floor, manger, feed 
box and adjacent walls, thoroughly' scrubbed with hot water, to 
which a reliable disinfectant in sufficient amount has been added. 

When infectious abortion breaks out among mares at pasture, 
they should be promptly removed from the field and placed in a 
stable, and the measures above outlined followed. Disinfection at 
pasture is impossible, for very evident reasons. It cannot be 
known when a mare at pasture aborts, especially when early in 
pregnancy. When abortion does occur, the fetus and its mem- 



Control and Eradication 493 

branes may lie undiscovered for a long time and act as a focus for 
the spread of the disease to other mares. The vaginal discharges 
are also dribbled about over the herbage, to more certainly dis- 
seminate the infection. The mare comes in close contact with 
pregnant companions and may readily transmit the infection 
directly to them. 

4. Exposed pregnant mares should at once be thoroughly dis- 
infected, and especially the anus, vulva, tail, buttocks and hind 
legs. These parts should first be thoroughly scrubbed with soap 
and hot water to which has been added carbolic acid or lysol. 
After this thorough scrubbing, the parts should be daily disin- 
fected with a warm 2 or 3% solution of carbolic acid or lysol, 
for six or eight days. 

5. Immediately after the occurrence of an abortion in a stable, 
or at the commencement of control measures, the vagina of all 
exposed mares which have not aborted, and have not been iso- 
lated, should be subjected to rigid disinfection by irrigating them 
with a warm i to 2000 corrosive sublimate solution. Should no 
subsequent abortions occur, the vaginal disinfection need not be 
repeated. 

After each fresh abortion in a herd, the control measures out- 
lined should at once be renewed, each separate abortion being 
regarded as fresh exposure of all contiguous animals. 

6. Ample precautions should be taken against the spread of 
the disease through the medium of secondary bearers. Blankets 
which have been used on mares which have recently aborted are 
highly dangerous when used upon, or brought in contact with, 
pregnant mares. Harness may bear the infection, as may curry- 
combs, brushes and other stable utensils. 

Workmen who have handled an aborted fetus, or its afterbirth, 
or who have cared for the aborted mare, may readily carry the 
infection to pregnant mares. Due precautions are to be taken 
against such accidents. The clothing of such persons should be 
kept clean ; if necessary, it should be disinfected. The hands 
especially become soiled with infection-laden substances and 
readily carry the malady. The shoes also constitute dangerous 
bearers of infection. The manure, or other filth from the stall 
where a mare has aborted, clings tenaciously to the shoes, and 
upon these the infection may be carried from one stable to 
another. 



494 Veterinary Obstetrics 

If practicable, different persons should handle the infected and 
the presumably non-infected animals, and they should not pass 
from the infected to the non-infected stables. 

When infectious abortion exists in a neighborhood, each person 
or animal approaching a stable where pregnant mares are kept 
should be regarded as suspicious and treated accordingly. Geld- 
ings, and mares not used for breeding, may serve as bearers of 
the disease from diseased to pregnant mares. Indeed, it is 
probable that the bacteria of the maladj' will live for a time in 
the vulva and vagina of a mare which has not been bred. Though 
such an animal does not become visibly diseased, she may never- 
theless be a very dangerous bearer of the malad}' to pregnant 
mares, and such danger should accordingly be avoided. 

Breeding should be suspended during an outbreak of contagious 
abortion. If a recently aborted mare is bred, and the stallion is 
then used to serve a mare from a stable in which there are healthy 
pregnant mares, the infection may first be transferred, through 
the penis of the stallion, from the diseased mare to the vagina of 
the healthy one and by her carried to healthy pregnant mares. 

When the disease becomes widely prevalent in an area, all 
breeding animals might properl}' be regarded as suspicious. If 
such a view is taken, each mare ma)' be regarded as possibly in- 
fected and, after permitting a stallion to serve her, the penis and 
surrounding parts of the male should at once be disinfected 
against a possible transmission of the disease to the next mare 
with which he copulates, and the carrying of the malady by her 
to healthy pregnant mares. 

In the infectious abortion of cows, with which we shall deal in 
the succeeding section, some veterinarians have recorded appar- 
ently good results in the eradication of the disease by subcu- 
taneous medication with carbolic acid ; others have attempted, 
with apparently good results, the production of serum immunity. 

If the abortion breaks out somewhat early during gestation, 
it may be essential to determine as positively as possible which 
mares are pregnant and which are not, and for this reason it may 
become necessary to carefully examine each mare per rectum, in 
doing which the veterinarian should guard against danger to the 
fetus, from the manipulation, as well as against the transmission 
of the disease from one mare to another through the medium of 
his soiled hands or clothing. Consequently it would be well for 



Infectious Abortion i?i the Cow. 495 

the veterinarian, in case such examination is made, to thorough- 
ly disinfect the tail, buttocks and perineum of the mare about 
to be examined and then thoroughly disinfect his arms and 
hands after the examination, before proceeding to the next mare. 
The handling of dystokia dependent upon contagious abortion 
is the same as that of dysiokia due to other causes. The se- 
quelae of abortion, such as retained placenta, metritis, laminitis, 
etc., present the same symptoms and are subject to the same 
rules of handling as apply to these diseases following parturition, 
and will accordingly be considered along with the post-parturient 
maladies. The disinfection of the animal should be complete. 
The disinfection of the veterinarian's person and his equipment 
should be emphasized, although in all obstetric work this pre- 
caution should be ample and should render the veterinarian 
secure against becoming a bearer of any infection to animals which 
he may later attend. 

B. Infectious Abortion in the Cow. 

For more than half a century, the leading veterinarians of the 
world have recognized the fact that most abortions occurring in 
cows are of an infectious character. The infectiousness of 
abortion was quite generally denied until near the middle of the 
19th century, but even during the i8th century there were vet- 
erinarians who had become thoroughl}' convinced of its trans- 
missability. When a very large number of abortions occurs in a 
given herd or in a community during a short period of time, they 
are quite uniformly traceable to infection. 

Infectious abortion of cows occurs chiefly in dairy herds and 
only rarely among animals bred for beef purposes. It is not so 
much a question of the susceptibility of one animal as of the 
environment of the respective animals and the interchange of 
animals, by which the disease may be spread from one herd to 
another. Dairy cows are kept confined in close contact with 
each other throughout a part or the whole of the year, so that 
there is a better opportunity for infection by ordinary contact. 

Another element which tends to largely confine the malady to 
dairy herds is the fact that among dairymen there is frequent in- 
terchange of cows and bulls for breeding purposes. Among 
breeders of beef cattle, the interchange of animals is compara- 
tively rare and consists chiefly in the breeder buying young bulls, 



496 Veterinary Obstetrics 

which have not been previously used. In those sections of the 
countr}^ where beef breeding is the principal industry, it is found 
that a large proportion of the outbreaks of contagious abortion 
occur in those herds where pedigreed stock is bred and where 
there is frequent interchange with other breeders or the animals 
are habitually exhibited at agricultural fairs, where they become 
exposed to the malady. 

Etiology. The bacteriology of infectious abortion of cows has 
not been fully determined, and the findings of different investi- 
gators are very contradictory. Bang, and those in accord with 
him agree that the malady is due to a short bacillus. This is a 
non-motile organism which contains no spores but, when arti- 
ficially cultivated, frequently shows, at one end, a spherical en- 
largement. The micro-organism is easily stained with analine 
dyes, either aqueous or carbolized. It does not color by the 
Gram method. It may be artificially grown in an atmosphere of 
oxygen or in the almost complete absence of oxygen, but does not 
grow rapidly in ordinary air. It may be grown on gelatine, agar 
and various other media. In these media it grows in clumps the 
size of a pin-head, which are conical in form and have very definite 
outlines and, in transmitted light, have a bluish color. The 
bacillus perishes in these artificial cultures in about two weeks 
and is readily destroyed by heat and disinfectants. It is claimed, 
however, that they may continue to exist in the secretions of 
the uterus for month after month. According to experiments 
recorded hy Bang (Jour, of Comp. Path, and Therap., Vol. 19, 
page 191) the injections of pure cultures of this organism into the 
vaginae of pregnant cows and sheep caused abortion or premature 
birth in 8 to 10 weeks, in which cases the micro-organism was 
obtained in pure cultures from the vaginal discharges, as well as 
from the exudate upon the surface of the cotyledons and the 
chorion. 

Bang also injected abortion bacilli into the jugular vein and, 
in case of two pregnant ewes, living lambs were produced. The 
specific abortion bacilli were found in the chorion. The same 
experiment was tried upon a pregnant mare, which gave birth 
after 27 days to a very small foal which died a day later. Here 
again he found, upon the chorion, bacilli which could not be 
differentiated from those which had been injected into the vein. 

Bang injected a pure culture of the micro-organism into the 



Infections Abortion of the Cow 497 

jugular vein of a pregnant cow, which aborted 90 days later, and 
in the exudate upon the afterbirth he found the abortion bacilli. 
In this connection he states: "Since that time we have made 
more or less extensive experiments with cows, sheep, goats and 
rabbits, and produced abortion in this way." One may infer 
from these experiments that, while it is not proven that the 
abortion of the mare is identical with that of the cow, he suspects 
that such may be the case, and that, consequently, when con- 
tagious abortion breaks out among cows, other pregnant animals 
should be protected against exposure. 

Having satisfied him.self that the bacilli could be carried to the 
uterus through the blood, Bang suspected the possibility of the 
organisms reaching the uterus through the alimentary canal 
also. He administered ^ of a liter of an artificial culture of the 
bacillus in bouillon serum to a pregnant cow, on the 12th of June, 
and on the 7th of Sept. he gave her a quantity of exudate from 
an aborted cow. She gave birth to a living calf on the 26th of 
November, 80 daj's after having been fed upon the exudate. In 
the typical exudate upon the afterbirth, there were abundant 
bacilli. L,ater he repeated this experiment under conditions 
which, he claimed, "excluded the possibility of infection in 
any other way than through feeding." The heifer aborted 56 
days later. 

How the possibility of infection by other avenues was excluded 
in this experiment does not appear. If the bouillon, exudate 
and cotyledons were given to these animals as a drench or mixed 
with food, we see no reason why portions of the liquid escaping 
from the mouth might not soil the food or bedding, to later be 
accidentally moved backward and reach the posterior part of the 
stall, making it possible for the infection to gain entrance through 
the vulva. If the material were given in any other way than in 
an impermeable capsule, the mouth would inevitably become in- 
fected and the cow, in licking her posterior parts, as she habitu- 
ally does, could transfer the micro-organisms to that portion of 
her body, whence they might enter the vulva. 

Even should the abortion bacilli pass into the alimentary tract, 

we have no evidence that they may not resist the action of the 

digestive fluids, appear in the feces and enter the vulva. The 

mere assumption that the bacilli may be taken up from the in- 

32 



498 Veterinary Obstetrics 

testines and carried to the uterus involves the persistence of the 
bacilli in the presence of the digestive fluids and the possibility of 
their appearance in the feces. 

While it seems quite possible that the infection may be intro- 
duced in this way, we question very much if it constitutes an im- 
portant source of danger. If the food were infected it would be 
virtually impossible to be sure that the infection might not reach 
the vagina and uterus, even though it did not do so through the 
alimentary canal. 

The problem of the transmission of infectious abortion, either 
equine or bovine, by the introduction of bacteria into the blood 
or subcutaneous tissues, or by penetrating the mucous membrane 
of the digestive tract after having been swallowed, is a very 
interesting one requiring elucidation. Can bacteria, large 
enough to be recognized and clearly identified, without causing 
symptoms of maternal disease, pass through the maternal pla- 
centa, without inducing visible injury to the uterus, and cause 
a fatal disease of the fetus in the uterus ? The evidence on this 
point needs be very much more exact before accepting an affirma- 
tive conclusion. 

Bang claims that the abortion bacillus is purely pathogenic and 
does not lead a saprophytic existence. He kept the baccilli alive, 
but dormant, for 7 months in test tubes at a low temperature. 
In one case he found the abortion bacilli in an exudate surround- 
ing a mummified fetus, which had been dead apparently for nine 
months. According to his view, apparently, the bacilli may live 
for an almost indefinite period within the uterus of the cow and 
-be capable at a future time of starting anew the malady. 

As stated on page 476, the bacteriolgic researches of Bang are 
in apparent conflict with those of Ostertag. While B. succeeded 
in causing abortion in various species of animals with the abortion 
bacillus of the cow, O. utterly failed to transmit, to the cow or 
other animals, the infectious abortion of the mare by the exudate 
or afterbirth from aborted animals or through his abortion coccus. 

Braiier (Deutsche Zeitschrift fiir Tiermedicin, Vol. XIV, p. 
95) recognized a micrococcus as the cause of infectious abortion 
in cows and experimentally induced the disease with the micro- 
organism. Franck also recognized a micrococcus as the cause 
of the malady. Nocard recognized both micrococci and bacilli 
in the uterine discharges and fetal fluids. 



hifedious Abortion of the Cow 499 

Many elements serve to confuse the question of the bacteri- 
ology of infectious abortion. The normal bacterial flora of the 
vulvo- vaginal cavitj' of the cow has not been as f UII3' determined 
as desired. Nocard has investigated outbreaks of what appeared 
to be simultaneous contagions of infectious abortion and dysen- 
teria neonatorum or diarrhea of the new-born. Others have 
believed that infectious abortion and infectious diarrhea of the 
new-born were identical. 

The period of incubation of the infectious abortion of cows 
is as much in dispute as the bacteriology of the affection, and 
adds to the confusion regarding the latter. Bang makes the 
incubative period two to seven months. This is wholly out of 
harmony with clinical experience with infectious diseases in 
general. Most transmissable diseases show a period of incuba- 
.tion ranging between three and twenty days, so that an incuba- 
tion stage of eight to twent5r-'eight weeks naturally causes some 
doubt. 

Braiier, Lehnert and others record an incubative period of nine 
to twenty days. Such a period is in harmony with the incuba- 
tion period of infectious abortion in the mare and with the 
incubation period of infectious diseases generally. 

The incubation period of infectious abortion, whether by ex- 
perimental or natural infection, is probably more variable than 
most infectious maladies. The infection per vulvam is not 
direct. We have no definite knowledge of the time required for 
the infection to traverse the vulvo-vaginal and cervical canals 
before it can attack the fetal membranes. After the infection of 
the fetus and its membranes has occurred, expulsion usually 
does not follow until after the fetus has perished. In the cow, 
with the rigid cervix, it is not improbable that in many cases, 
the fetus is retained one, two or more days after its death before 
its expulsion. Since we generally regard the period of incuba- 
tion in infectious abortion as extending from the date of expos- 
ure to the expulsion of the fetus, we evidently include not only 
the time generally alloted to incubation but also the duration of 
the disease itself. 

It is highly important that additional observations be made 
upon the period of incubation. If the infecting micro-organism 
can live in the gravid uterus, in the fetus or its membranes, for 
six or seven months, that fact is extremely discouraging in 



500 Veterinary Obstetrics 

connection with the control of the malady. We know no way 
to disinfect the pregnant uterus, and if the infection may exist in 
it for seven months there can be little hope for the prompt 
eradication of the disease from a herd. 

The Method of Natural Infection doubtless varies greatly 
in different instances. Consequently one author will place the 
principal emphasis upon a given method and another upon a dif- 
ferent avenue of infection. Bang places considerable stress upon 
infection through the alimentary tract by means of contaminated 
food. While such a possibility should be recognized, we have 
little evidence that it plays a highly important part in the major- 
ity of outbreaks. 

Some writers probablj' over-emphasize the frequency with which 
the disease is transmitted by the male breeding animal through 
copulation. Doubtless this mode of transmission is quite im- 
portant, and should be fully recognized in all plans for control 
or eradication. When, however, a cow aborts during the 5th to 
7th month of gestation, we are skeptical about the correctness of 
attributing the disease to infection by copulation. If the cow 
came in estrum during pregnancy, and copulated with the male, 
we might readily admit that the infection was probably trans- 
mitted in that way. Bang, in his published researches, makes 
the period of incubation in experimental cases about 8 to 10 
weeks and in some rare cases as long as 12 weeks, but when he 
considers the transmission of the infection by the bull he ap- 
parently considers the period of incubation as much as 6 or 7 
months, which seems to us to raise a very serious question of 
doubt. If the infection is capable of producing abortion at all, 
and is introduced by the penis of the male at the time of copula- 
tion, it would seem more reasonable to expect the bacilli to destroy 
the life of the fetus at a very early period, or perhaps even the 
ovum or spermatozoa prior to fertilization, and cause an invisible 
abortion. We do not believe that copulation constitutes the chief 
means of transmission nor that we should finally conclude that 
abortions occurring late during pregnancy are due to this mode 
of infection. 

Clinical evidence indicates that the disease is most frequently 
transmitted, either directly or indirectly, through the vulvo- 
vaginal canal, from a cow which has recently aborted to one 
which is pregnant. If the disease breaks out in a stable, it tends 



Infectious Abortion of the Cow 501 

to spread first to those cows which are nearest to the aborted 
animal. In some outbreaks which have been recorded, it has 
been shown to spread chiefly in the direction of the slope of the 
gutter, apparently because the liquid discharges from the vulva 
had passed along the gutter and soiled the bedding of the suc- 
ceeding cows. As in the mare, it seems quite certain that the 
infection is readily transferred from one animal to another by 
persons who are caring for the animals. Milkers may readily 
carry the disease from one animal to another upon their hands, 
thus transmitting it from udder to udder, from whence it may be 
transferred to the vulva through the medium of the tail or by 
other means which readily suggest themselves. 

Symptoms. The symptoms of infectious abortion in the cow 
seem to be somewhat more pronounced than in other animals. 
It occurs most frequently in animals 5 to 6 months pregnant, al- 
though Bang records cases as early as 3 months and admits that 
it may occur very near to the end of gestation and that, in some 
cases, the diseased fetus may be born alive in a weakened state 
and may either perish within a few days or recover and continue 
to live. 

Nocard states that when the calves are prematurely born 
alive, as a result of infectious abortion, they sometimes bawl 
in a peculiar manner, which would suggest to one the howling of 
a rabid dog. Nocard attributes this to involvement of the me- 
dulla oblongata. He was possibly dealing with infectious diar- 
rhea affecting the calf at the same time. 

There is some tendency to the appearance of the symptoms of 
genital catarrh as the forerunner of abortion. The vaginal mu- 
cosa becomes injected and the lips of the vulva somewhat swollen. 
Bang regards the malady essentially as an insidious uterine 
catarrh. Naturally the injection of the vulvar mucosa, accom- 
panied by vaginal discharge, would follow. 

Whether the swelling of the vulva and discharge from the 
genital tract are the effects of the death or serious disease of the 
fetus and of the disea.se process taking place in the fetal" mem- 
branes, or whether they constitute a fundamental part of the dis- 
ease itself, is not known. It has not been shown that the vulvar 
tumefaction and discharge precede the death of the fetus. If the 
swelling and discharge occur only after the death of the fetus, 
they should be regarded as the precursors of the expulsion of the 



502 Veterinary Obstetrics 

dead fetus rather than as a sign of impending fetal death. The 
disease has already worked its greatest harm by destroying the 
life of the fetus. It should be noted that such a condition does 
not occur in the non-pregnant animal as a result of exposure to 
infectious abortion. 

Indeed we have no evidence to show that the micro-organism of 
infectious abortion has any power to produce symptoms of dis- 
ease of any kind whatever in a non-pregnant animal. Even 
when pure cultures are injected into the jugular vein, they cause, 
according to Bang, only a temporary slight fever which quickly 
abates, and no further evidence of disease is observed until abor- 
tion occurs. It would consequently seem that there is some- 
thing in the composition of the fetus, its fluids or membranes 
which makes it possible for organisms to multipl}^ and to bring 
about pathologic conditions. 

Hutyra and Marek state that the mucous membrane of 
the vagina sometimes shows granular enlagements as large as 
hemp seed. This seems to correspond with the mo.st prominent 
symptom of the infectious nodular vaginitis of cows and 
may be simply a co-existence of the two diseases in one animal. 
It is to be remembered also that the nodular or granular venereal 
disease .may cause abortion in 60 to 70 % of pregnant cows. See 
page 98. There occurs a white, reddish gray or yellow vaginal 
discharge. Two or three days later abortion occurs. Reindl 
records that, in the case of a bull, he observed small nodules 
upon the penis, which were similar to those seen in the 
vaginae of cows just prior to their having aborted. This suggests 
that he also was dealing with the infectious nodular catarrh 
of cattle, possibly complicated with true infectious abortion. 

When abortion occurs early in gestation, the fetus is usually 
expelled included in its membranes. L,ater in gestation the fetus 
is usually expelled naked and the membranes follow somewhat 
tardily. In a large proportion of cases, the afterbirth is retained 
and requires artificial removal. After the abortion has occurred, 
if the afterbirth has come away spontaneously or has been 
promptly removed, there frequently occurs a discharge froin the 
genital tract, which continues for two or more days or as many 
weeks. This discharge is usually of a reddish-brown or reddish 
color, generally a repulsive appearing liquid containing small 
clumps of pus and fragments of afterbirth, and in some cases is 



Infectious Abortion of the Cow 503 

more or less fetid. I^arge quantities of this discharge may ac- 
cumulate in the uterus and later be expelled at intervals, or the 
flow may be virtually continuous. 

Generally the aborted fetus is dead, but not greatly, if at all, 
decomposed when expelled. Rarely the fetus is born alive. If 
dystocia occurs the fetus soon decomposes. The afterbirth is 
usually more or less discolored, there is edema and injection of the 
chorion, and between the cotyledons there is frequently seen a 
muco-purulent exudate. When a cow has once aborted and is 
bred soon afterward, it is claimed that she is very liable to again 
abort from the infection which caused the prior abortion and has 
persisted in the uterus during the entire period. This has not been 
well established. If the bacillus is already present in the uterus 
at the time of copulation, it would seem more probable that it 
would destroy the life of the spermatozoa and of the ovum even 
before impregnation took place. Should the ovum and sperma- 
tozoa escape such a fate, it would appear probable that abortion 
would occur so early during gestation that the expulsion of the 
very small embryo would pass unrecognized. 

Diagnosis. Hutyra and Marek, and other writers, place great 
diagnostic value upon the swelling of the vulva and the genital 
discharge, which usually occur two or three days prior to the ex- 
pulsion of the fetus. If the reliability of these symptoms can be 
clearly established, they become of fundamental importance in ref- 
erence to the control and eradication of the disease by leading 
to earlier diagnosis of the presence of the infection in a given 
individual. When the abortion has occurred, some authors 
claim that the existence of a fibrino-purulent exudate upon the 
chorion speaks for the infectious nature of the disease, but it has 
apparently not been fully determined that the infectious abortion 
can thus be safely differentiated from that occurring from other 
causes. 

Once the disease has become established in a herd, the best 
proof of its character is the gradual and more or less rapid spread 
of the affection from cow to cow. In many cases this is ex- 
tremely rapid when the disease assumes a highly virulent type, 
whereas in other instances, when the disease has lost its virulence 
in a community or stable, the spread is very much slower and 
may be spontaneously confined to a very small percentage of the 
pregnant cows in the herd. Hutyra and Marek, citing Cagny, 



504 Veterinary Obstetrics 

observe that sometimes in young cows and mares there occurs a 
swelling of the vulva and a discharge of mucus, along with some 
slight symptoms of general disturbance, which later disappear, 
and the animal completes the period of gestation and gives birth 
to vigorous, living young. 

Some investigators hold that a microscopic examination of the 
discharges from the vagina, and the indentification therein of the 
abortion bacillus, constitutes one of the most rapid and reliable 
methods for diagnosing the disease. 

It would appear, however, that, while the symptoms recorded 
above are all valuable in aiding the veterinarian to reach a con- 
clusion, until the disease is much better known than at present, 
it is safer to regard any case of abortion in a dairy as suspicious 
of being due to infection and to treat it as such, especially if 
that malady already exists in the vicinity or if a new animal has 
been introduced into the herd, which might carry with it the 
infection. 

Infectious abortion is to be carefully differentiated from the 
granular venereal disease, which, although causing abortion in 
50 to 70 % of the pregnant cows attacked, is nevertheless a quite 
distinct malady and offers a different problem in handling. 

Since our account of this disease on page 97 has come from 
the press, the malady has been definitely recognized in Northern 
New York and is possibly extensively distributed in America. 
Its recognized existence in America demands that it should 
receive more extensive consideration at our hands. This we 
shall accord to it in an appendix. 

The course of abortion in a stable or herd is very much like 
that of any other infectious disease. Upon its first appearance 
it usually assumes a highly virulent character and for a time 
may increase in virulence, to later slowly and gradually abate 
as if it had consumed the fuel upon which it might feed. 
Finally the disease gradually disappears, unless new material is 
constantly provided by the introduction of new cows which have 
not previously been exposed to the malady. Investigators of the 
disease usually claim that a cow will abort two or three times 
from the infectious disease and, after such a period, usually ceases 
to abort and again breeds. A large proportion of the cows which 
abort two or three times, however, are sold and thus disappear 



Infectious Abortion of the Cow 505 

from the herd and from observation, so that the data upon this 
point are probably not very reliable. 

The control and eradication of the disease in cows is a prob- 
lem which requires a very careful, detailed study in each instance, 
upon the part of the attending veterinarian. In a herd or stable 
where the disease exists, the same precautions should be insti- 
tuted as we have already suggested, on page 488, for the mare. 
Cows which have aborted should be promptly removed from the 
stable ; the aborted fetus, afterbirth and soiled bedding should 
be carefully removed and burned ; and the stall and gutters should 
be thoroughl}' disinfected. The aborted cow should be effectively 
isolated, and the uterus daily flushed out with a warm antiseptic 
solution, such as i to 2 % of creolin or lysol. The solution should 
be of sufficient volume to fill the uterine cavity several times, so 
that the cleansing may be complete. 

Each pregnant cow should be carefully observed, and if any 
signs of impending abortion appear, such as a vaginal discharge 
with swelling of the lips of the vulva, she .should be promptly 
removed and the stall thoroughly disinfected. 

The vulva, perineum, tail and neighboring parts of each ex- 
posed cow should be thoroughly washed daily for at least two 
weeks with strong antiseptics, such as a 2 or 3 % solution of creolin 
or carbolic acid or a i-iooo solution of corrosive sublimate. 

Whatever may be the possibilities of the invasion of the infec- 
tion through other avenues, it must be admitted from all clinical 
data that the most important, if not constant portal, is the vulvo- 
vaginal canal. This renders it fundamentally important that the 
vaginae of all cows, whether pregnant or not, in a stable where 
the disease exists, shall be thoroughly disinfected. A neglect of 
this precaution may leave the infection undisturbed for days or 
weeks, to later penetrate the gravid uterus and cause abortion in 
the animal harboring it, or serve as a new center of infection by 
escaping in the vaginal discharges to prove a menace to neighbor- 
ing pregnant cows. 

It is not advisable to use so strong a solution for irrigating the 
vagina as that suggested above for disinfecting the external 
parts, but instead one should employ a comparatively non-irritant 
antiseptic solution, in order to obviate severe straining, such as 
a I to 2 % lysol or carbolic acid solution. This should be in- 
jected into the vaginae daily for two or three days. We cannot 



5o6 Veterinary Obstetrics 

readily use corrosive sublimate solution in the vagina of the cow,, 
because it produces too great irritation of the mucous membrane 
and causes severe straining. In the mare, as related on page 492, 
we can introduce into the vagina a warm corrosive sublimate solu- 
tion of the strength of 1-2000 or 2500 without causing severe 
irritation, but the cow does not endure it so well. 

Brauer recommends very highly the use of subcutaneous injec- 
tions of a 2 % solution of carbolic acid, 20 or 30 cm', to be given 
every two weeks during the period of danger. Combined with 
these, he recommends the same regulations in reference to 
disinfection which we have already related. 

The bull should also have strict attention, as a probable bearer 
of the infection. It is highly inadvisable to allow a bull which 
is in use in a given herd to serve cows from other herds where 
abortion exists, and it is equally imprudent to permit a cow from 
an apparently healthy herd to be sent to a bull which has been 
used among infected cows. 

When there is a suspicion of danger from the bull, and 
it is desired to use him, the prepuce and penis should be carefully 
disinfected before and after copulation. 

The disinfection of the prepuce of the bull is best accomplished 
by means of a piece of pure gum tubing, )^ to yi in. in diameter 
and 4 to 6 feet in length, provided at its distal end with a funnel, 
into which the disinfecting fluid may be poured and thence flow 
by gravity through the tube into the prepuce. The force of the 
liquid may be moderated by the height at which the funnel is 
held. The most convenient form of rubber tubing procurable is 
the ordinary pure gum horse catheter. 

The distal end of the rubber tube is inserted into the preputial 
opening and held in place during the operation. The orifice of 
the prepuce about the tube should be grasped and closed while 
the fluid is entering, causing a large volume of the disinfectant 
to enter the sheath and fill the entire cavity. Such distension of 
the cavity obliterates the mucous folds and enables the disinfec- 
tant to reach every part of the surface. Any reliable disinfectant 
may answer the purpose. The sheath will ordinarily withstand 
a warm i to 2000 corrosive sublimate solution or a 2 to 3 % lysol, 
creolin or carbolic acid solution. The long hairs about the pre- 
putial opening should be clipped away so as to render the part 



Infectious Abortion of the Cow 507 

more readily cleansed. The entire preputial region should be 
scrupulously cleansed and disinfected. 

Great care should be taken at all times by owners of dairies or 
herds of breeding cows to prevent the introduction of the infec- 
tion into the herd. One of the most common means for intro- 
ducing abortion from a distance is the purchase and introduc- 
tion into the herd of new cows or bulls for breeding purposes. 
New breeding animals should always be kept isolated from the 
general herd, until it is evident that they are free from any in- 
fection. It may even be advisable to thoroughly disinfect the 
genitals of new breeding animals, as a precaution, before using 
them for breeding purposes. 

It is important also, if the owner of a herd desires to eradicate 
abortion from his premises, that he shall not introduce new ani- 
mals while the disease is active. Should it become necessary to 
purchase new animals, they should be kept apart from the in- 
fected herd and cared for by persons who do not come in contact 
with the other animals. Neither should an owner sell animals 
which have aborted and buy new ones, with a view to getting 
rid of the disease. He can much more readily control the disease 
and eradicate it from the premises, by keeping the infected herd 
and applying means which we now regard as reliable for control- 
ling the malady, than by disposing of the aborted animals and 
procuring new ones. 

It is still more unfortunate, and to be vigorously condemned, 
for the owner of an infected herd to sell his cows for breeding 
purposes, without imparting to the buj^er a full knowledge of 
the circumstances. Unscrupulous dealers may thus spread and 
distribute the infection over a wide area of country. The selling 
of cows which may be bearers of infectious abortion for any other 
purpose than immediate slaughter should be strictly prohibited 
by law and, so long as it is not, a sense of moral duty should 
prevent an owner of such cows from selling them in a way to 
render dissemination of the disease probable. 

C. Abortion in Other Domestic Animals. 

Infectious abortion in other domestic animals than the mare 
and cow is not very common, but we find instances recorded of 
comparatively severe losses from this disease in sheep, goats and 
swine. In these animals the disease has not been extensively 



5o8 Veterinary Obstetrics 

studied and there is nothing known regarding the character of 
the organism which causes the malady in each. 

The symptoms and course of the infection are essentially the 
same as in the mare and cow, and the abortion usually occurs at 
a corresponding epoch in gestation ; that is to say, they usually 
abort early during the second half of pregnancy, but the abor- 
tion may occur at any time. 

In the present state of our knowledge, we would apply the same 
fundamental principles to the control of the disease which we 
have suggested in the mare and cow. It is evident that we can- 
not so effectively apply some of the measures in these small ani- 
mals as in the larger ones. We cannot so well disinfect the male 
genital organs and consequently need to take other equivalent 
measures by isolating the male and not using him for breeding 
purposes for a longer time than if we were able to thoroughly 
disinfect the parts. Similar conditions prevail in reference to the 
disinfection of the genital tract in the female, because we cannot 
so readily introduce the hand into the uterus and make sure that 
the afterbirth has been removed, nor can we readily introduce 
disinfectants into the uterine cavity itself. Therefore, we will 
generally need to isolate the aborted animals for a longer period 
of time, until we can safely assume that disinfection has taken 
place in a spontaneous manner, before we shall again permit them 
to be bred and thus take the risk of continuing the spread of the 
disease. Aside from these considerations, there is nothing in the 
present state of our knowledge to suggest any variations in the 
problem of control and eradication from that which we have al- 
ready considered in connection with the disease in the mare 
and cow. 



NORMAL PARTURITION. 

Normal parturition is the birth or expulsion of the living fetus 
at the natural time, without artificial assistance and in a state of 
development which enables it to live. Although the act of 
parturition is a ph}'siologic one, it is accompanied by pain and 
severe exertion upon the part of the mother and brings about 
sudden changes in the life of both mother and fetus which in a 
measure imperil the well-being of each. 

The phenomena of birth vary greatly in detail in species and 
individuals and in no two are they precisely the same, either in 
the period at which they occur after impregnation, the length 
of time required for the expulsion of the fetus by the mother, 
the amount of force required for its expulsion, or in any other of 
the numerous details of this act. The fetus may present in many 
different ways for its passage through the birth canal, or offer a 
very wide degree of variations in detail and yet be virtually 
normal. A very slight divergence in a given direction may cause 
deviation of a part which may render birth more or less difficult, 
or even'impossible without aid. 

The causes of parturition are not definitely known. We have 
learned in preceding chapters that birth normally takes place 
after a somewhat definite duration of intra-uterine life, but the 
variations of the length of time in the larger animals, like the 
mare and cow, may reach extremes of 90 days or more, so that we 
cannot say that parturition is inevitable at a certain time. We 
know that the uterus and other portions of the genital tube un- 
dergo certain developments during pregnancy which constantly 
tend to fit them more and more for the act of birth, when that 
phenomenon finally appears, but there seems to be nothing in 
this development which marks a limit and designates a definite 
stage at which the uterus will necessarily expel its contents. 

In studying the development of the fetus, we have noted that 
certain changes take place in its organs of circulation and nutri- 
tion and that they gradually acquire a completeness which clcsely 
simulates that which is seen in the adult animal. In this way 
the organism becomes fitted for an independent existence. 
However, there is nothing in this development which seems to 
mark a definite stage at which the fetus must be expelled. 
509 



510 Veterinary Obstetrics 

According to researches made by various investigators, there 
is progressive fattj' degeneration of the decidua or of that portion 
of the uterine mucous membrane which constitutes the external 
layer of the maternal placenta, so that eventually the nutrition 
of the fetus is disturbed and threatens to be cut off, and 
consequently it must be born. 

This view of the cause of birth would suggest that the fetus 
itself largely takes the initiative in the act, but this would 
scarcely seem to be true in any important sense. It is a quite 
common observation that, just prior to birth, the fetus shows 
more or less vigorous movements, but we do not know whether 
these are due to some such cause as the foregoing or if they are 
the result of a re-action to the pressure exerted upon it by the 
contractions of the uterus, preparatory to the expulsion. We 
very well know by clinical experience that, if we touch or grasp 
a fetus from the vagina or rectum, it at once struggles and, if 
we grasp one of its extremeties, it immediately attempts to with- 
draw it. Accordingly, if the uterus begins contracting upon 
the fetus and disturbs its position, the fetus performs more or less 
vigorous movements, in an effort to adjust its position to the 
changes in form which are taking place in the uterine cavity, 
due to the contractions of its walls and the opening of the os 
uteri. 

Movements of the fetus are not essential to its expulsion, as is 
frequently observed in cases of abortion and in stillbirths, where 
the fetus is usually expelled with promptness and under the 
same general conditions as in normal birth. It is only in excep- 
tional instances that a dead fetus is retained within the uterus, 
and then we usually have some recognizable cause for such re- 
tention, which fully explains the departure from the rule that, 
when a fetus dies, it is expelled. 

In a general way we attribute the act of birth to a reflex irri- 
tation of the nerves of the uterus. The causes of this reflex 
irritation we do not fully understand and they do not seem to 
always be the same. On page 227 we have noted the fact that 
abortion may be brought about by the pressing out of the corpus 
luteum from the ovary of the pregnant female. This apparently 
induces contractions of the uterus which cause the expulsion of 
the immature fetus, thus showing, or tending to show, that the 
presence of the yellow body in the ovary of the pregnant female 



Normal Parturition 511 

inhibits expulsive muscular contractions of the uterus. We 
have also learned, on page 165, that normally the corpus luteum 
begins to disappear late during gestation and that at the time of 
birth it has become completely atrophied. The relation of this 
•disappearance of the yellow body from the ovary to the expulsion 
of the fetus has not been studied and may be quite interesting, 
as it possibly exerts a highly important influence upon birth. 
We know that the death of the fetus, as already stated, tends 
constantly to excite a reflex action in the uterine walls, which 
brings about contractions and the expulsion of the dead fetus. 
We know also that, in case of the aseptic death of the fetus, 
followed by mummification, the presence of the cadaver does not 
excite this reflex action, but permits the dead fetus to remain as 
an inert body in the uterine cavity for an indefinite period of 
time. It therefore seems that it is not so much the death of the 
fetus which, in this case, causes its expulsion as it is a beginning 
of putrefaction. It is not impossible that the excretions of the 
fetus after a time become so important in quantity and character 
that, passing into the blood of the mother, they bring about a 
certain irritation upon the central nervous system and cause con- 
tractions of the uterus, with the expulsion of its contents. 

The Expelling Powers. The initial powers by which the 
fetus is expelled from the uterus reside in the unstriped muscle 
walls of the uterus itself, but the final power is very largely de- 
rived from the abdominal walls, including the diaphragm. 

L,abor pains are diminished or inhibited in many cases by cir- 
cumstances of varying character. When there is torsion of the 
uterus to an extreme degree, there are no prominent labor pains 
present, because the contractile power of the uterus is destroyed. 
In transverse development of the fetus in the uterus of the mare, 
the physical relations of the fetus to the organ are such that they 
inhibit any very marked labor pains, and while we have good 
evidence of some uterine contraction, by the dilation of the os 
uteri and the expulsion of portions of the fetal membranes, we 
do not observe the vigorous expulsive efforts of normal parturi- 
tion. It may be stated that we do not generally observe a full 
exertion of the expelling powers in any of those cases wherein 
the conditions are such that the fetus cannot pass from the uterus 
through the cervix into the vagina. 



512 Veterinary Obstetrics 

The force of the uterine contractions is not very apparent to 
the observer. The obstetrist recognizes them during parturition, 
when he inserts his hand between the fetus and uterine walls 
during labor. But, in cases of dystokia, the obstetrist does not 
note so vividly the contractions of the uterus, but observes chiefly 
the great pressure whicl^, is exerted upon his hand and arm when 
the animal makes violent expulsive efforts by the contraction of 
the abdominal walls and the increase thereby of the intra-abdom- 
inal pressure. 

The uterine contractions dilate the os uteri, expel the fetus 
unaided in case the contractile power of the abdomen is destroyed 
by extensive rupture, and, after the birth of the fetus, expel the 
placenta. 

By observing the contractions of the pregnant uterus when it 
is exposed to the air, we find that the movements are of a char- 
acter closely analogous to intestinal peristalsis. At what time 
these contractions of the uterus begin, in relation to parturition, 
we do not know. Probably contractions of a peristaltic type 
occur continuously throughout the entire period of gestation, not 
of a character to threaten the expulsion of the fetus, but of a kind 
to favor its normal development and maintain its normal position. 

Fleming maintains that during the labor pains the entire 
uterus contracts, but that the fundus does so most energetically. 
This opinion is apparently drawn from human obstetrics, because 
the uteri of domestic animals have virtually no fundus, and con- 
sequently contractions could not occur chiefly in that part. 

Clinical observations upon the larger domestic animals would 
indicate that contractions of the muscular walls of the uterus 
frequently commence two or three days, or even longer, in ad- 
vance of parturition, and that they are manifested by the appear- 
ance of slight colicky pains. This is especially noted in the 
mare, and suggests that labor is threatened and that there is 
actually some pain present, due to the vigorous contractions of 
the uterine muscles. These symptoms may appear in a very 
mild form for several days in succession before real expulsive 
efforts begin. As a general rule they pass unnoticed, and it is not 
until there are added to the uterine contractions, the expulsive 
powers of the abdominal walls that we really observe their 
presence. 



Normal Parturition 513 

When discussing the position of the fetus in the uterus toward 
the end of gestation, we took occasion to note that it is not rare 
to find a portion of it extending beyond the cervix and resting 
in a cul-de-sac of the uterus alongside the vagina. When partu- 
rition comes on, if the abdominal muscles alone should act on 
the fetus, they would simply tend to push the fetus further on- 
ward in this cul-de-sac and threaten finally to rupture the uterus. 

If, on the other hand, the uterus contracts first, and especially 
the longitudinal fibers, their contraction would efface the cul-de-sac 
of the uterus alongside the vagina. This brings the presenting 
part of the fetus into a conical cavity which terminates with the 
OS uteri and places the fetus in a position and direction which will 
permit of its expulsion. 

The uterine contractions are essential for the dilation of the 
OS uteri. Whenever these contractions take place, and conse- 
quently increase the intra-uterine tension, the walls yield at the 
point of least resistance. Normally this yielding occurs at the 
cervix, causing it to become dilated, and later the cervix and os 
uteri to become wholly effaced, so that the uterine and vaginal 
cavities are merged into one common passage, without any line 
of demarcation between them. 

The contractions of the uterus during the act of birth are 
essential to the maintenance of the organ in its position in the 
abdominal cavity. If the expulsive powers were dependent upon 
the abdominal muscles alone, the uterus would tend to become 
expelled along with the fetus and thus to induce a prolapse, but 
the uterus, by its contraction, is able to maintain a natural posi- 
tion throughout the act and to avoid being pushed back into the 
vagina. 

The dilation of the cervical canal is dependent partly upon the 
shortening of the longitudinal muscle fibers of the uterus, but 
largely upon the pressure of the fetal membranes, with the con- 
tained fluids, against its anterior opening. With the increase of 
intra-abdominal tension, the fluids about the fetus tend to move 
most readily toward the os uteri and push along with them the 
membranes. The fetal fluids within the membranes serve as an 
elastic dilator which, slowly becoming impacted in the os uteri, 
gradually dilates the passage by exerting equal pressure upon 
every part. 
33 



514 Veterinary Obstetrics 

It is well to note that the os uteri is very much more dilatable 
when the force is exerted from before backward — intra-uterine 
force — than from behind forward — extra-uterine force — as the 
■obstetrist must largelj^ do when applying forcible means for dila- 
tion of the OS uteri. As the os uteri becomes dilated and the 
cervix effaced, the pressure within the uterus presses the fetal 
membranes, with the contained fluids, out through the os uteri, 
vagina and vulva, until they appear externallJ^ 

The relations of the various fetal membranes to each other, and 
to the contained liquids, bring about very marked differences in 
the various animals. The chorion ruptures without having 
moved from its original position, or becoming extensively' de- 
tached from the uterus. Normallj^ it can not protrude far 
through the os uteri. It is essential that this should be so be- 
cause it is through the maintenance of the intimate relation be- 
tween the chorion and the uterus that the life of the fetus is 
maintained during the time of parturition. If the chorion should 
become so detached from the uterus as to interrupt the inter- 
change of nutriment or excretions betjveen the mother and the 
fetus, the life of the latter must quickh' terminate unless the act 
of birth is abruptly completed. Normally, therefore, the chorion 
may push out only a little way from the os uteri before rupturing, 
without interfering materially with its general attachments to 
the uterus through the placenta. After the rupture of the 
chorion, some of the allantoic fluid may escape into the vagina 
and later externally. Through this rupture in the chorion, the 
posterior extremity' of the amnion regularly protrudes until it 
reaches the vulva and projects out between the vulvar lips for 
some distance. 

The allantoic sac of ruminants, that is, the endoblastic portion 
of the allantois, is so disposed that it may protrude through the 
rupture in the chorion to constitute the first ' ' water-bag. ' ' In 
the mare this cannot occur independently of the chorion. Rupture 
of the protruding allantoic sac occurs early, and is followed by 
the appearance of the second or true ' ' water-bag ' ' which consists, 
as in other animals, of a portion of the amniotic sac enclosing 
some amniotic fluid. 

In the cow and mare the protruding portion of the amnion, or 
"water-bag," appears as an elongated bladder with a thin, color- 
less membrane filled with a clear fluid. The bag may extend for 



Nortnal Parturition 515 

a distance of 6 to 10 inches beyond the vulva, and contain from i 
to 4 or 5 pints of amniotic fluid. With each labor pain, more of 




FiG. 87. NoRMAi, Position of FeTus of Cow at Time 
OF Birth. (Skelett.) 



5i6 Veterinary Obstetrics 

the amniotic fluid is pushed out into the water-bag, until finally 
the tension becomes too great and it ruptures. Slightly before 
this period, in normal cases, the presenting portion or portions 
of the fetus, usually the two anterior feet, followed closely by 
the nose, appear in the " water- bag." 

Under rnore or less abnormal conditions, there are great varia- 
tions in reference to the behavior of the fetal membranes at this 
stage of labor. In the mare it is possible for the chorion to 
become completelj- detached from the uterus without becoming 
ruptured. Consequently the fetus is in some cases said to be 
expelled completely encased within all its membranes. This is 
apparently a general statement and we do not know of a well 
authenticated instance where it has occurred in a fully developed 
fetus, though it is frequently seen in the mare, as well as in other 
animals, when abortion takes place at an earlj' period in gesta- 
tion. In one case which we observed, the chorion ruptured at 
the anterior end and was pushed over the fetus and expelled, 
along with the amnion, while the dead fetus remained in the 
uterus, owing to some deviation in its extremities which inter- 
fered with its expulsion. 

In cases of twin pregnancy, it is essential that but one fetus 
should enter the birth passage at a time. In the cow and ewe 
ordinarily, when there are twins, one occupies each horn in part, 
while a portion of each fetus projects more or less into the body 
of the uterus and, when labor pains come on, that fetus which 
chances to be most advanced ordinarily gains the cervical canal 
and pelvic inlet first and by its presence prevents the other from 
entering. Thus the two fetuses are born one after the other. 

In practice, this favorable disposition of twin fetuses is occa- 
sionally interrupted by some portion or portions of each fetus 
simultaneously entering the pelvic canal and causing more or less 
serious dystokia. 

We have no evidence to show that the uterine contractions in 
the two horns may not be essentially equal, but apparently they 
soon become concentrated upon that portion of the organ which 
contains the fetus in the most advanced position, and consequently 
where the contractions will prove most efficient. As soon as the 
first fetus is expelled and the passage thus vacated and dilated, 
the expulsion of the other one, as a rule, follows very promptly. 

In the mare, only a few minutes usually elap.se between the 



Normal Parturition 517 

expulsion of the first and the second fetus. In the cow, where 
the act of parturition is more deliberate, there is a greater interval, 
sometimes 20 or 30 minutes. Under abnormal conditions the 
interval between the expulsion of the two fetuses may be much 
greater. The birth of the second of a pair of twin fetuses may 
be delayed for hours or even days after the birth of the first. 
Any great delay in the expulsion of the second fetus is usually 
■due to some exhaustion in the contractile power of the uterus, 
resulting from the expulsion of the first fetus and the advent of 
a subsequent period of rest before the renewal of labor pains for 
the expulsion of the second fetus. 

In multiparous animals, theentanglement of two fetuses during 
parturition cannot well occur. No fetus, or parts of a fetus, nor- 
mally occupies the uterine bod)'. The fetuses are wholly lodged 
within the two cornua. The body of the uterus is actually nar- 
rower, when labor sets in, than are the two gravid cornua, so that 
it is quite impracticable for a fetus from each horn to enter simul- 
taneously the body of the uterus. One fetus enters at a time and 
it is assumed that they enter alternately from the two cornua, so 
that the two are emptied nearly together, that is to say, that one 
horn is not completely emptied of its fetuses until the other is 
also emptied of all but one. 

Symptoms of Parturition. Preliminary to the completion 
of pregnancy there appear certain signs which indicate to us, 
with more or less certainty, the near approach of labor. 

One of the most conspicuous of these is the increased func- 
tional activity of the milk glands. In all of our domestic animals 
there is a tendency for the glands to become gradually enlarged 
and tense as the period for giving birth to young approaches. 
The date at which this enlargement appears varies, being of 
longer duration in primipara than in those which have previously 
given birth to young. Usually a few weeks before birth there 
appears in the udder at first a watery secretion, which may be 
pressed from the teat, but which bears only a faint resemblance 
to milk. Later the secretion becomes more milk-like and assumes 
the characters of colostrum, which some claim is essential to the 
well-being of the young. When parturition is near, the milk 
secretion may be so profuse that it escapes from the teat in drops, 
or in streams. 



5i8 Veterinary Obstetrics 

However reliable this is as a sign that parturition is near, 
it may become very misleading. We have previously stated that 
sometimes during various stages of pregnancy the glands become 
swollen and contain milk and that this may disappear and not be 
seen again until at the close of pregnancy, weeks or months 
later. 

Sometimes the milk glands become much enlarged and show 
great functional activity long before parturition, so that in the 
mare we have observed a profuse flow of milk escaping from the 
glands for two or three weeks before the birth of the foal, though 
everything seemed to be normal and parturition was regular. We 
have also noted in previous chapters that we have at times ob- 
served the secretion of milk by a mule during the estrual period. 

On the other hand, it sometimes occurs, especially in the mare, 
that almost no milk is secreted prior to parturition and that the 
glands are very slightly enlarged. Such is especially the case in 
very old mares which have been bred for the first time. 

Fleming suggests that this enlargement and increased func- 
tional activity of the udder is due to the diversion to it of the 
excess of blood from the uterus, which this organ no longer re- 
quires. This explanation is not clear. The nutritive demands 
of the fetus at the close of intra-uterine life seem to be even 
greater than at an earlier period. The fetus is larger and grow- 
ing rapidly. The uterus must receive an increased amount of 
nutriment, in order to perform its function of expulsion of the 
fetus and placenta and repair of the injuries incident to parturi- 
tion. It is rather a part of the general plan of nature in preparing 
for the nutrition of the fetus after its birth. 

A very important sign of approacliing parturition is the re- 
laxation of the sacro-sciatic ligaments, which allows the muscles 
passing over them to drop inward causing a sinking of the croup. 
This relaxation increases the dilatability of the vulvo-vaginal 
canal and makes it easier for the fetus to be propelled through 
it. The relaxation in these ligaments is thought by some to be 
due to changes taking place within the ligament itself, consisting 
largely of an effusion of lymph into it, which leads to its soften- 
ing. Others refer the phenomenon to a change in the relationship 
between the ossa innomiuata and the sacrum and coccyx. The 
sacro-iliac ligaments, according to this view, become somewhat 
relaxed, so that the articulation becomes less rigid and the 



Normal Parturition 519 

tuberosity of the ischium passes upward toward the sacrum and 
causes a decrease in the tension of the great sacro-sciatic 
ligaments. 

Another symptom of approaching birth, which is important, is 
the preparation which is taking place in the vulva. The vulvar 
lips become somewhat thickened and tend to stand apart more 
loosely than ordinarily. From the vulva there generally appears, 
especially in the cow, a more or less abundant discharge of a 
thick, ropy mucus, which indicates an increase in the functional 
activity of the glands in the mucosa of the vagina and vulva. 
If the lips of the vulva are parted, there is observed an injection 
of the mucosa. 

As the time for birth draws nearer, certain psychic signs are 
observed, which indicate that the period of labor is rapidly ap- 
proaching. The animal seems to be somewhat disturbed and 
anxious. It tends to move slowly and cautiously and exhibits 
some tendency to isolate itself from its usual associates. There 
may be interruptions in feeding, suggesting that uterine contrac- 
tions are taking place, which cause some degree of discomfort 
or pain. These may express themselves through an appearance 
of anxiety on the part of the animal. Sometimes the advent of 
the uterine contractions is suggested by the appearance of slight 
colic, accompanied by occasional pawing or lying down, or, in 
case of carnivora, whining or groaning. The mare may show 
evidence of pain by whisking the tail, a symptom which is seen 
to some extent also in the cow. Finally the pregnant animal, if 
at liberty, tends to withdraw from other animals of its own kind 
or of other species and seek a quiet and secluded place, where it 
may bring forth its young without disturbance or annoyance. 

In herbivora, little care is taken in the selection of a place for 
giving birth to young, except that it is a quiet spot where the 
mother and young may for a time remain more or less in hiding. 
The carnivorous animal shows a tendency to select a comfortable 
bed. 

The sow, in a state of freedom, will habitually gather coarse 
herbage or small brush into a conical mound, in which she may 
give birth to her young. If allowed the fullest liberty, at a 
season of the year when vegetation is abundant, she will select a 
spot where she can gather an abundance of coarse weeds or fine 
twigs which are covered with leaves. Beginning at the spot 



520 Vetermary Obstetrics 

which she selects for her nest, she will gather all the herbage in 
an ever widening circle and carry it to the central spot, where 
she deposits it in the form of a mound, until she has acquired 
sufficient to suit her purposes. We have seen such mounds as 
extensive as four or five feet in diameter and two or three feet in 
depth. Into the center of this mound she crawls in such a way 
as to become almost or quite hidden and there gives birth to her 
young. In confinement, she builds such a nest as her environ- 
ment makes possible or demands, and it may vary in every degree 
from that which we have already described to no bed at all in 
some cases where she is denied the proper material for its con- 
struction. Increased domestication brings decreased instinct in 
preparing such bed. 

The rabbit constructs a burrow and pulls from her own body a 
sufficient amount of fur to line a very complete and cozy nest in 
which to give birth to her very immature j^oung. 

Exploration of the genital passages just prior to labor reveals 
the fact that the cervix of the uterus has largely disappeared, 
and there simply remains a brief constriction at the os uteri ex- 
ternum. The OS may be somewhat open, so that the fingers can 
readily be introduced into the uterine cavity and come in contact 
with the smooth surface of the chorion over the small area 
where no placental tufts exist. As labor progresses, the os uteri 
gradually dilates and, when the contractions of the uterine walls 
become more pronounced, the dilation of the os uteri externum 
rapidly increases, until it finally becomes wholly effaced and the 
uterine cavity continuous with that of the vagina. 

When the os uteri has become sufficiently dilated, the water- 
bag passes into and through the opening and portions of the 
fetus soon advance into the os uteri and vagina and the definite 
symptoms of labor quickly become established. The uterine 
contractions now begin in earnest and are soon accompanied by 
contractions of the abdomen and diaphragm. The animal shows 
well marked pain and suffering. Depending somewhat upon 
species, the animal shows a tendency to lie down and rise fre- 
quently, and in general to show abdominal pain. The mare 
may paw with the fore feet and strike at the abdomen with 
the hind feet. The animal ceases to feed and shows much 
anxiety, which is indicated to some extent by a disturbance of 
the circulation, consisting chiefly in an increased pulse rate. In 



Normal Parturition 521 

the mare, there may be some sweating. The pain is somewhat 
intermittent and after each uterine contraction, which is of 
variable length but which rarely exceeds two or three minutes, 
there is a pause in the pain and anxiety until another period of 
contraction comes on. As the uterus is an unstriped muscle 
organ, its contractions are more or less slow, are virtually in- 
voluntary and, like other contractions of this type of muscle, are 
rythmic and recur at more or less regular intervals. The uterine 
contractions are almost wholly involuntary, but may be indi- 
rectly modified by fear or other emotions. As soon as the fetal 
membranes pass into and beyond the os uteri, the expulsive 
efforts of the animal increase in force and the full power of the 
abdominal and other muscles of the body is brought into play in 
a supreme effort to bring about the expulsion of the fetus. 

When the labor pains become fully established, the animal 
assumes varying attitudes, somewhat according to the species 
and individual. Our larger domestic animals alternate between 
the standing and recumbent positions during labor, while multi- 
parous animals lie almost continually and chiefly in lateral re- 
cumbency. The larger animals, when standing, arch the back, 
bring all the feet together and strain violently. This straining 
is aided materially by the animal taking a deep inspiration of 
air, closing the glottis .so that the air cannot escape from the 
chest, and then powerfully contracting the muscles of the body, 
increasing enormously the intra-abdominal pressure and tending 
to force the contents of the abdomen in the direction of least 
resistance. With the contractions of the uterus, this force is 
concentrated chiefly upon the fetus and its envelopes, and forces 
them toward and through the dilated os and out through the 
vagina and vulva. 

Herbivorous animals do not constantly maintain a given posi- 
tion during labor, but vary their attitude somewhat according 
to the progress of parturition and partly according to indi- 
vidual temperament. During the earlier stages of the act there 
is a greater tendency to maintain the standing position, than 
later. When the fetus has been well propelled into the pelvis 
and the anterior feet and head have passed beyond the vulva, 
there is a very marked tendency, in the cow and mare, to as- 
sume the recumbent position, and the animal may lie either in 
the sternal position, or prone upon the side, in lateral recum- 



52 2 Veterinary Obstetrics 

bency. Even here the position tends to vary to some degree, 
especially in the mare, according to the stage of the act. The 
mare generally lies upon her sternum until the head of the fetus 
has protruded some distance beyond the vulva, when, should 
she continue this position, there would be a tendency for the 
fetus to strike against the floor or ground and offer obstruction 
to its further expulsion. At this period she usually assumes 
lateral recumbency, in which position she is capable of exerting^ 
the maximum expulsive power, while the fetus may be expelled 
without obstructing its long passage by contact with the ground. 

The standing position of large animals at the close of the ex- 
pulsion of the fetus is unfavorable for the well-being of the young, 
because of the possibility of its injury in falling. It is not the 
best position for the mother, because she cannot exert the maxi- 
mum degree of force. 

In the multiparous animals the contraction of the abdominal 
muscles plays a comparatively unimportant part in the expulsion 
of the fetus. This is brought about chiefly by the contractions 
of the muscular walls of the uterus itself. 

The " water bag " performs a highly important ofiice in the 
expulsion of the fetus. We have already suggested that, in the 
dilation of the os uteri, the bag of water tends to bring this 
about, in the safest, gentlest, and yet most effective manner 
possible, by producing an equal pressure in every direction, 
lyater it dilates the vulvar opening also, although here it is not 
so important because, when the water bag reaches this part, the 
membrane protrudes through the vulva and the fetal liquid is 
forced through the vulva in a stream, to accumulate on the out- 
side till the amnion ruptures and the fluid escapes. Exception- 
ally, the " water bag " is said to not rupture in the mare, and the 
foal to be expelled inclosed within it. 

In normal parturition, the allantoic and amniotic fluids serve 
to lubricate the passages throughout labor, and portions of the 
fluids remain within the uterus after the fetus has been expelled. 
The presence of thi^ fluid in the uterus serves to fill out and efface 
all irregularities in the form of the fetus and prevents the uterus 
from closely investing the body of the fetus in such a way as to 
interfere with its expulsion. 

Should the uterus contract directly upon the irregular fetal 
body and closely invest it throughout, it could not exert that 



Normal Parturition 523 

power upon the fetus essential to its ready expulsion. The 
uterus maintains a more or less spherical shape while the fetal 
fluids are retained, and consequently presses alike upon all por- 
tions of the fetus, and tends to press it backward through the 
vagina and vulva. 

When dystokia occurs and the fetal fluids all escape, the ob- 
stetrist is made to realize the disadvantage of the absence of 
these and the close investment of the fetus by the uterine walls. 
This condition prevents him from readily changing the position 
of the fetus or from carrying out other manipulations. After the 
position of the fetus has been adjusted, the obstetrist still needs 
the fetal fluids. The uterine and abdominal contractions tend to 
force out some of these liquids with each labor pain, and conse- 
quently keep the passage constantly moist and somewhat 
unctuous throughout the entire duration of normal parturition. 

The dilation of the passages is favored by the part of the fetus 
which normally presents. In the larger herbivora, the vast 
majority of fetuses present with the two anterior feet, followed 
shortly by the nose resting upon them at about the middle of the 
metacarpus. The three extremities constitute an elongated 
cone, which acts as a wedge in gradually dilating the passages. 
If the fetus presents posteriorly, the conditions are essentially 
the same, in reference to the mechanical plan, and the two hind 
feet present together. As the legs and thighs are advanced they 
serve again as a long wedge or cone to gradually dilate the pas- 
sages for the expulsion of the fetus. In carnivorous animals, 
where the head is proportionately very large and the anterior 
limbs are comparatively small and flexible, the head usually ad- 
vances alone and the fetus is expelled with the anterior limbs 
lying along the side or floor of the fetal chest. 

When the young of large herbivora present anteriorly there is 
usually no very serious impediment to their progress until the 
head of the fetus reaches the vulva, when, especially in primipara, 
there is a delay in the progress of the fetus because time is re- 
quired to bring about the dilation of the vulva to such a degree 
that the fetus can pass through without serious injury to the 
part. When the head emerges from the vulva, the other parts 
of the fetus usually pass with less difSculty, though there may 
be marked resistance when the chest enters the passages and 



524 Veterinary Obstetrics 

again when the hips advance until they come in contact with the 
pelvic inlet of the mother. 

It is important to bear in mind that in our larger domestic 
animals the fetus lies en arc and that, in passing through the 
pelvic canal, in anterior presentation, the head and forefeet must 
pass upward and backward, and, when these extremities emerge 
from the vulva, the expulsion of the other portions of the fetus 
most readily occurs with the head and shoulders passing first back- 
ward and then downward and backward so that the fetus retains 
its arciform disposition. 

If we measure an ordinary fetus, after its delivery, we find 
that the diameters of its chest are greater than those of the canal 
through which it has passed, and that consequently there must 
be some change in these diameters during its passage from the 
uterus. This is brought about, in the mare and cow, chiefly 
by the extreme extension of the shoulders, causing them to be 
displaced forward from the chest and lie chiefly upon the sides of 
the neck, anterior to the first rib, with only the prolongation of 
the scapula resting upon the chest. At the same time the sternum 
is drawn far forward, so that the sterno-spinal diameter of the 
chest is greatly decreased. This makes it possible for the chest 
to pass through an opening which measures less than its own 
diameter. This change in the relations of the chest and anterior 
limbs occurs in the larger domestic animals, whether the present- 
ation be anterior or posterior. 

When the hips reach the constricted portions of the passages 
they are not capable of any great change in form or volume and 
must necessarily pass through the birth canal approximately in 
their normal form and size and sometimes constitute a more or 
less serious impediment in the expulsion of the fetus. 

The duration of normal parturition in animals is extremely 
variable, both according to species and individuals, and is de- 
pendent upon many circumstances. It is usually more prolonged 
in primipara, because the birth canal has not previously been 
dilated. 

In the mare, where the vulva is very large and the cervix of 
the uterus very extensible, parturition is exceedingly prompt 
and, we might say, tumultuous. This is necessitated, in a large 
measure, because of the feeble attachment of the placenta, which 
tends to very rapidly become separated and cause the death of 



Normal Parturition 525 

the fetus through the cutting off of the nutritive supply, includ- 
ing oxygen. Hence, foals generally perish if dystokia occurs. 
This is in sharp contrast to ruminants, where the fetus may con- 
tinue to live for hours after labor has set in. Consequently, in 
the mare the actual duration of vigorous labor usually does not 
extend beyond a few minutes and occasionally occurs so quickly 
in a work mare that she can scarcely be unhitched from the plow 
and have her harness removed before the living foal has been ex- 
pelled. In cows which have given birth to a number of calves, 
the birth act is sometimes almost as prompt, although usually it 
is more prolonged because the os uteri does not dilate so readily 
and the labor pains are not so tumultuous and powerful. 

In multiparous animals, the birth of each young animal usually 
follows quickly upon that of the preceding. A sow may bring 
forth 8 to 10 young in less than an hour. Sometimes parturition 
becomes tedious and a sow may be a day or more in expelling the 
fetuses. 

When the fetus is expelled, the effect upon the umbilic cord 
will depend somewhat upon the position of the mother, but very 
largely upon the length of the cord. In the mare, the umbilic 
cord is quite long and the fetus may be completely expelled and 
the cord continue intact so long as the animal remains in a recum- 
bent position. When she arises, the cord will probably rupture 
and, if not at that moment, it must give way when she turns to 
examine her young, if the chorion remains attached in the uterus. 
In some cases, however, the afterbirth immediately follows the 
fetus and remains attached to it by means of the cord until the 
foal itself ruptures it by its struggles. 

The umbilic cord of the foal ordinarily ruptures at a point 
about two inches from the umbilic ring, and just beyond a 
point where there is a distinct line of demarcation between the 
cord proper and the cordiform extension of the abdominal wall, 
which is not covered with hairs. (See Fig. 90 B.) The ex- 
act point of rupture may vary, however, and the cord may 
become torn in two, 5 or 6 inches or even more from the um- 
bilic ring, or it may give way very close to the ring. It has 
been alleged that the rupture may occur in the ring, but the 
writer has not observed such an accident and its occurrence 
may be doubted. The rupture of the umbilic cord is followed 
by some hemorrhage, especially if the placenta still remains 



526 Veterinary Obstetrics 

attached and consequently receives blood up to the moment 
of rupture. The umbilic cord may bleed from either end. 
From the placental end only that blood which has already en- 
tered its vessels from the mother usually escapes. From the fe- 
tal end there may ooze a few drops of blood from the broken 
ends of the umbilic veins. Some claim that there may be 
a more or less serious hemorrhage from the umbilic arteries, 
but this accident we have not observed. This can occur only 
very rarely, because the arteries are so elastic that they promptly 
recoil and retract up into the abdominal cavity, (Fig. 56), 
drawing their connective tissue envelopes along with them in 
such a way as to render hemorrhage virtually impossible. In 
all animals, there is a tendency for the mother to cleanse the 
ruptured navel cord with her tongue or lips. In the cow, the 
umbilic cord is so short that it usually ruptures before the hind 
feet of the fetus have escaped from the vulva. The necessary 
care of the broken umbilic cord will be discussed under "Care of 
the New- Born Animal." 



EXPULSION OF THE FETAL MEMBRANES AND INVO- 
LUTION OF THE UTERUS. 

The expulsion of the fetal membranes normally follows birth 
after a very brief interval, depending upon the species of animal 
and the individual. The expulsion of the fetal membranes occurs 
most promptly in those animals like the mare, in which, owing 
to the diffuse placenta, the attachments of the chorion to the 
uterus are not so complex and consequently not so difficult 
of detachment. In ruminants, with the multiple placenta or 
cotyledons, the attachments between the fetal and maternal pla- 
centa are very intricate and the placental villi very long and 
branched, so that they do not so readily become detached from 
the maternal organ. 

The detachment of the placenta is largely the result of the con- 
traction of the uterine walls, which, acting upon the villi of the 
fetal placenta, tends to force them out and detach them, while 
the decrease in the size of the uterine cavity forces the detached 
membranes out through the vagina. The contraction of the 
uterine walls of ruminants cannot act so effectivelj^ upon the 
cotyledons as can the walls of the uterus of the mare upon the 
diffused tufts. The contraction or involution of the uterus and 
the expulsion of the membranes are therefore correlated phenom- 
ena which go hand in hand, and when one fails it tends to 
interrupt the other. 

In the mare we have seen the entire placenta and all the fetal 
membranes promptly expelled from the uterus, while the fetus 
remained naked in the organ, because of some slight deviation of 
• a fetal part which prevented its ready expulsion. In this case 
the contraction of the uterus, with the escape of the amniotic 
and allantoic fluids, was sufficient to cause the detachment and 
expulsion of the chorion. Fleming suggests that the same acci- 
dent may occur in the cow, but this we have not observed. Owing 
to the character of the placenta in that animal, such an occurrence 
must be extremely rare, except in cases of prolonged dystokia, 
with decomposition of the membranes. 

In some cases of birth, in the mare, especially where there has 
been a slight delay, the fetal membranes accompany the fetus or 
follow it immediately. In cases of dystokia in the mare, as a 
527 



528 Veterinary Obstetrics 

general rule, the fetal membranes come away immediately fol- 
lowing the fetus, or essentially at the same moment. 

The placenta usually comes away, in the mare, a few minutes 
after birth and, in the cow, at a somewhat later period. In the 
multiparous animals, the afterbirth which has belonged to a 
given fetus must be expelled before the succeeding fetus from 
the same horn can be born, and consequently, as a rule, we ob- 
serve the placenta of each fetus following it immediately and 
usually still attached to it. 

The detachment of the fetal membranes or placenta in the 
normal way has little or no tendency to induce important hem- 
orrhage in animals. Though the hemorrhage following detach- 
ment of the placenta in animals is quite uniformly of no conse- 
quence, it is present in a sufficient amount that we are able to 
say that it occurs. However, in the larger domestic animals, it 
generallj' amounts to a quantity which is scarcely capable of be- 
ing measured and which is wholly without visible consequence to 
the animal. We do see hemorrhage, however, from the placenta 
of the larger animals when the fetal membranes are injudiciously 
and violently torn away. Following such cases we have seen 
fatal hemorrhage. 

Frequently the fetal membranes do not come away promptly, 
but are retained for a greater or less period and may result seri- 
ously for the well-being of the animal. They are especially liable 
to be retained in cases of abortion and also in all those cases where, 
for any reason, the involution or contraction of the uterus is tardy. 

As soon as the fetus has been expelled and the umbilic cord 
ruptured, the chorion, and other portions of the fetal membranes 
remaining, become essentially inert tissue, without circulation 
and without life. It is highly essential that these should come 
away promptly and that the involution of the uterus should take 
place quickly. When this fails to occur promptly, the fetal 
membranes quickly become infected and undergo decomposition; 
the uterus becomes infected and leads to metritis, placentitis, or 
to other more or less serious infections. Two things are essential 
to prevent these infections : the expulsion of the membranes and 
the contraction of the uterus. Even if the membranes are 
promptly expelled, it is essential that the uterine cavity should 
be effaced and the walls come in contact, in order to avoid in- 
fection in the uterine cavity. Any relaxation or debility of the 



Expulsio7i of Fetal Menibrayies ; Involutioii of the Uterus 529 

uterine walls invites infection. A contractile organ has in itself 
the power to overcome infection ; hence the importance of the 
normal contraction of the organ. Retention of the placenta will 
be more fully considered later. 

The expulsion of the fetus and its fluids is at once followed by 
contraction of the uterine walls, decreased vascularity, reduction 
in size and obliteration of its cavity b3^ the walls coming in con- 
tact with each other. The placentse disappear, the glandular 
layers of the deciduate placentas are detached and removed and 
anew epithelial layer formed at the site of placental attachments. 

The cervix uteri contracts rapidly and the cervical canal is 
well closed in 24 to 48 hours. The uterus, once pregnant, fails 
to wholly regain the size of the virgin organ. The broad liga- 
ments retract and again suspend the uterus. 

Collectively we know these processes as involution of the 
uterus, and regard them as highly important to the well-being of 
the animal. When the uterus contracts in a physiologic manner 
it tends to prevent infection of its walls, but if there is inertia or 
paralysis of the walls, infection is probable. If afterbirth or 
other dead tissue remains in the uterus and becomes infected, 
the infection not only brings about an inflammation of the 
uterine walls, but also increases the inertia or paralysis of them. 

In most domestic animals, the mother habitually devours the 
entire fetal membranes immediately after their normal expulsion. 
This regularly occurs in ruminants and the sow, and some- 
times, it is said, in the mare also. It has been suggested 
that the devouring of the fetal envelopes by the mother is the 
persistence of a precautionary measure from the wild state, for 
the defense of the mother and new-born against predatory 
animals, by destroying the evidences of the recent birth. The 
devouring of the membranes rarely results in accident, but there 
have been a few ca.ses recorded where a cow has become choked 
upon her placenta and, in one case personally related to us, the 
cow became choked while the one end of the placenta still re- 
mained firmly attached in her uterus. Sometimes the placenta 
decomposes in the rumen or other portions of the alimentary 
canal and causes indigestion. 



34 



PRESENTATIONS AND POSITIONS OF THE FETUS. 

In a general way, we have already outlined the physiology of 
labor and have indicated the means by which the fetus is expelled 
from the uterus when it has completed its intra-uterine develop- 
ment or when it has been thrown out because of its death or 
disease in case of abortion or premature birth. 

It is essential that we should thoroughly understand that, in 
order for these physiologic processes to be carried out in a normal 
manner, it is necessary for the attitude of the fetus to be such 
that it will be practicable for it to pass through the birth canal. 
There are certain attitudes of the fetus which make its passage 
possible, while others render it virtually impossible. The possi- 
bility of a fetus being born alive and without assistance depends 
fundamentally upon which parts of the fetal body present at the 
inlet, and secondarily upon the relations of the parts which 
present to the circumference of the pelvis. In dealing with the 
mechanism of parturition, we recognize two fundamental ele- 
ments in reference to the attitude of the fetus — presentation and 
position. 

Presentation, mechanically expressed, is the relation existing 
between the spinal axes of the mother and fetus. The term in- 
dicates that portion or general region of the fetus which offers 
at the pelvic inlet at the time of parturition. 

Position expresses the relation of the presenting portion of the 
fetus to the circumference of the pelvic inlet. It is the relation 
of the presenting part to the sacro-pubic or the bis-iliac diame- 
ter of the maternal pelvis. 

Presentations of the Fetus. 

The uteri of domestic animals are more or less tubular in their 
general outline, and the fetus represents an elongated oval, the 
long axis of which normally corresponds with the long axis of 
the uterine cavity. The transverse diameter of the body of the 
fetus approximately equals the dimensions of the dilated birth 
canal, through which it must necessarily pass in being born. 
The fetal chest has an even greater diameter than that of the 
bony canal through which it must pass. Not only is it necessary 
that the long axis of the fetus should be parallel to that of the 
530 



Presentatio7is of the Fetus 



531 



mother, but even the transverse axis of the fetal chest must ba 
decreased. We ma^', therefore, recognize two normal attitudes 
of the fetus in relation to its long axis — the anterior and pos- 
terior presentations, in which the anterior or posterior end of the 
fetus respectively presents at the pelvic inlet. 

The mere fact that the spinal axes of the mother and fetus are 
parallel does not insure that the attitude of the fetus is normal . 
or that parturition can take place without aid, but merely that, 
upon examination, some portion of the anterior or posterior part 
of the body is met. 




Fig. 88. Posterior Presentation. 
Dorso-sacral position. (St. Cyr. ) 

Not every fetus, however, is presented in such a way that its 
long axis corresponds to that of the mother. Instead, it may be 
perpendicular to it, so that the fetus presents transversely, in 
which instance it cannot be born without a correction of its pre- 
sentation, and therefore becomes abnormal. 

The fetus may present transversely at the pelvic inlet, either by 
its dorsal or ventral surface, and consequently there may occur a 
dorsal or ventral presentation. 



532 



Veterinary Obstetrics 




Dorsal Presentation. (Franck) 




Fig. 90. Ventral Presentation. (Franck). 



Positions of the Fetus. 

Position is the relation existing between an arbitrarily selected 
part of the presenting portion of the fetal bod)' and the circumfer- 
ence of the pelvic girdle. A fixed point upon the fetal body, the 
dorsum for the longitudinal presentatipn, and the head end for 
the transverse presentation, is chosen as a basis. The pelvic inlet 



Positions of the Fetjis 533 

of the mother is divided into quadrants which represent the sac- 
rum, pubis and right and left ilia. Toward either of these areas the 
dorsum of the fetus may be directed, whether presenting by the 
anterior or posterior end. 

It does not follow that the dorsum of a longitudinally present- 
ing fetus is always directed toward the center of one of the four 
areas mentioned, but there may be every possible degree of vari- 
ation, the four cardinal points of the pelvic girdle serving as a 
basis for the designation of the intermediary or "oblique" 
positions, or simple variations, by which any one position may 
gradually merge into the next. In the longitudinal presenta- 
tion, the fetus tends to spontaneously assume that position in 
which its dorsum corresponds to the sacrum of the mother. 
This we designate as the dorso-sacral position. (See Figs. 87 
and 88). 

It is pre-eminently the normal position. While it is the- 
oretically possible for birth to occur, without assistance, in 
other positions of the longitudinal presentations, such has but 
rarely been observed. In the anterior presentation and dorso- 
sacral position, the disposition of the three extremities, the head 
and two anterior limbs, determines the practicability of the fetus 
being expelled without assistance. In animals with long and 
rigid limbs and a small head, such as the large herbivora, the 
normal relationship is for the two anterior limbs to be fully ex- 
tended, with the soles of the feet presenting downward, while 
upon these rest the head and neck with the nose .somewhat less 
advanced than the two anterior feet. In the mare the nose rests 
in the vicinity of the fetlocks ; in the cow the nose is somewhat 
nearer to the hoofs. Any deviation in the relationship of these 
extremities at once causes difficulty in the passing of the fetus 
through the birth canal and brings about more or less serious 
dystokia. 

If the fetus revolves upon its long axis to the extent of a 
quadrant of a circle, either to the right or the left, the dorsum of 
the fetus corresponds to the right or left ilium respectively and 
causes the right or left dorso-ilial position, a position of the fetus 
which renders spontaneous birth difficult in all cases, and usually 
impossible without obstetric aid. 

Should the revolution of the fetus upon its long axis continue 
a quadrant further, the dorsum of the fetus corresponds to the 



534 Veterinary Obstetrics 

pubis of the mother, or there occurs the dorso-pubic position. 
This position of the fetus is such that birth cannot usually take 
place without assistance and may consequently be regarded, for 
all practical purposes, as abnormal. In both the dorso-ilial and 
dorso-pubic positions, numerous deviations or misplacements of 
any or all extremities may occur and add to the complications 
and difficulties of the expulsion of the fetus. 

We have already stated that the fetus normally lies en arc or 
curved somewhat ventralwards. The anatomy of the fetus pre- 
vents this curvature from being readily reversed, and consequent- 
ly this curve of the body should always correspond to whatever 
curvature exists in the birth-canal. A study of the genital pas- 
sage of the mother will show that this curvature, in the main, is 
concave above and convex below. Consequently, if the curved 
body of the fetus is to pass readily through the canal, it must 
present in such a position that its convex dorsal surface shall cor- 
respond to the concave line formed by the maternal sacrum and 
coccyx. Hence the dorso-sacral position is the normal one, be- 
cause it is that which is most favorable to the prompt and easy 
passage of the fetus through the birth-canal with safety alike to 
the fetus and mother. 

In those positions where the curvature of the fetal body does 
not correspond to that of the birth-canal, the extremities of the 
fetus tend to push against the sides or walls of the canal and be- 
come impacted therein, injuring more or less seriously the soft 
parts of the mother or blocking the progress of the fetus. It is 
also to be considered that when the dorsum of the fetus cor- 
responds to the sacrum of the mother the actual transverse diam- 
eters of the fetal body assume the most favorable relations to the 
various diameters of the pelvis of the mother. ^ 

In the smaller domestic animals, the limbs of the fetus are not 
so long comparatively, nor so rigid ; the neck of the fetus is 
usually much shorter. The body is less curved and more pliable, 
so that it may be more readily bent dorsal wards than in the 
larger animals. The head, in some of the smaller animals, such 
as the carniyora, is large and offers alone as great an obstruction 
as the head and forefeet together in the larger animals. There- 
fore, in smaller animals, the anterior feet and legs usually pro- 
ject backward beneath the fetal body and the head advances 
alone. Because of the more direct and cylindrical form of the 



Positions of the Fetus 535 

body, the position of the fetus in relation to the circumference of 
the pubic inlet is not so important, although even here the fetus 
is generally and most readily expelled in the dorso-sacral position. 

When the longitudinal presentation is posterior, instead of 
anterior, the same modifications of position prevail and are sim- 
ilarly designated. There is the dorso-sacral position, with the 
dorsum of the fetus presenting toward the sacrum of the mother ; 
the right and left dorso-ilial positions, with the dorsum of the 
fetus directed toward the right or left ilial shaft of the mother ; 
and the dorso-pubic position, with the dorsum of the fetus 
directed toward the pubis of the mother. Some writers designate 
these positions lumbo-sacral, lumbo-ilial and lumbo-pubic respect- 
ively. 

Authors are not in accord upon the question of whether we 
can properly consider any position of the posterior presentation 
normal in the large herbivora. Certain it is that only very, very 
rarely is a calf or a foal born alive in the posterior presentation, 
unless assistance has been promptly afforded and birth greatly 
hastened. Whenever the fetal body has been so far expelled 
that the fetal umbilicus has entered the pelvic inlet of the 
mother and the umbilic cord is compressed between the pelvic 
brim of the mother and the ventral wall of the fetus, the life of 
the latter is at once threatened. It must quickly die from as- 
phyxia unless very promptly expelled or extracted and permitted 
to at once breathe. 

Precisely how long a fetus may live after the umbilic cord 
becomes compressed between the pubis of the mother and the 
body of the fetus, cutting off the fetal circulation, is not known 
but it certainly cannot be for more than a few minutes. Some 
authors have suggested that, if the circulation be thus inter- 
rupted, the fetus at once inhales the amniotic fluid and thus 
drowns itself. We have found no data to show us to what extent 
this is true. It is evidently well-nigh impossible for such inhala- 
tion of fluids to occur clinically, because, at the moment when 
the strangulation of the cord occurs, the chest of the young 
animal is so tightly impacted in the inlet of the pelvis of the 
mother that it is difficult to understand how amniotic fluid or 
anything else could be inhaled. When the chest has pa.ssed 
through the birth canal, the head at once follows and it only re- 



536 Veterinary Obstetrics 

mains for the amnion to be removed from the nose to render 
respiration possible. 

While normal and easy birth in the large herbivora is virtually- 
limited to the dorso-sacral position of the anterior presentation, 
in the smaller domestic animals it is by no means rare for birth 
to take place easily and safely, for both mother and young, with 
the fetus in the posterior presentation. 

In the judgment of some obstetric writers, the expulsion of the 
fetus is more difficult when presenting posteriorly than anteriorly, 
but we have not been able to verify this opinion. In our expe- 
rience in the larger domestic animals, the posterior presentation 
is favorable, in so far as the amount of resistance to expulsion is 
concerned, provided always that the position of the fetus is dorso- 
sacral and that there is no deviation of the posterior limbs. 
When so presenting, the posterior part of the body forms a very 
elongated cone, which tends to dilate the passages gradually and 
causes the fetus to advance with the least possible difficulty. 
Some obstetrists suggest that the direction of the hair, being op- 
posite to that in which the fetus is passing, offers resistance, but 
it should be remembered that the fetal hairs are very soft and 
flexible and that, if properly lubricated by the fetal fluids, they 
offer virtually no obstacle. What little resistance they may the- 
oretically offer is far more than counterbalanced by the length 
and regularity of the cone which the posterior presentation fur- 
nishes. 

However, dystokia is more liable to occur in our larger animals 
when the fetus presents posteriorly than when it offers anteriorly. 
The increased tendency to dystokia seems to be be due largely to 
the tendency for the hind limbs to become deviated from the normal 
position of extension and one or both of them to be more or less 
retained beneath the fetal bod}' and thus offer obstruction to 
birth which cannot be overcome except by obstetric aid. In the 
mare and cow, also, there is a constant tendency for the fetus, 
when presenting posteriorly, to assume the dorso-pubic or dorso- 
ilial position, by which the arc of the fetal body is contrary to the 
curvature of the genital passage. 

The posterior presentation is undesirable and unfavorable in 
our larger domestic animals, not because it fundamentallj' offers 
serious obstacles to the expulsion of the fetus, but because it 
tends to imperil the life of the fetus during the act of birth, 



Position of the Fetus 537 

owing to compression of the umbilic cord before the fetus is in a 
position to breathe, and also because of the great tendency for 
deviation of the limbs to occur or for some unfavorable position 
of the fetus to exist, which may bring about more or less serious 
dystokia. 

The transverse presentations of the fetus, whether dorsal or 
ventral, offer, in each, two positions. The fetus necessarily lies 
horizontally, since any other attitude would be unstable, and the 
head must lie in the right or left flank of the mother, correspond- 
ing more or less intimately to the right or left maternal ilium. 
Accepting the fetal head as the fixed point of the fetus for desig- 
nating its position, there may exist either a right or left cephalo- 
ilial position, according as the head end of the fetus corresponds 
to the right or left ilium of the mother.* 

The presentations and positions, normal and abnormal, which 
a fetus may assume may be tabulated as follows : 

( h nterior Presentation \ ( Dorso-Sacral Position 
LongiludinaU \ \ Right or Left Dorso-Ilial Position 

( Posterior Presentation J ( Dorso-Pubic Position 

™ I Dorsal Presentation 1 f t)- . 4. t r* r^ t. 1 -,^■ ^ ^ •,. 

Transverse ^ Ventral Presentation j' { ^'g^* °'' ^^^^ Cephalo-Ilial Position 

This gives a total of twelve fundamental positions, most of 
which are abnormal. These positions may be further compli- 
cated by a great variety of deviations of the extremities. 



*According to some writers, there may be in the dorsal presentation a 
cephalo-sacral position, but they cite no clinical instances and the position 
is so unstable as to be at least very transitory if not impossible. 



MANAGEMENT OF NORMAL PARTURITION. 

In a general way it is safer that an animal be let alone during 
parturition, and that she be given an amount of freedom which 
will approach the natural state as nearly as possible. 

Under domestication, the environment has been so changed 
and modified that it is essential we should consider the question 
of the care and surroundings of the mother and fetus during the 
period of parturition. The essential preparations should be those 
which insure freedom and comfort. In the larger animals, like 
the mare and cow, which are habitually kept secured in stalls or 
stanchions and frequently among a number of other animals, the 
safety of both the mother and fetus is increased by providing 
greater liberty for the animal during parturition and separating 
her to some degree from other animals of the same or other species. 
Sometimes the owner is not able to command proper quarters for 
an animal while giving birth to young and may find it necessary 
to keep her tied by the head. In reality, this is usually compara- 
tively safe, providing always that the stall is so arranged as to 
guard the animal against the danger of becoming cast, and thus 
injuring herself. 

Provision should be made against injury to the fetus from 
defects in the stable or from the presence of other animals. A 
good stall in which the animal is tied up by the head is better 
than a poor box-stall, because in the latter the mother is liable to 
lie down with her buttocks against or near to a wall in such a 
way that the fetus cannot readily be expelled, whereas if tied by 
the head in a single stall such an accident could not readily oc- 
cur, unless the stall were very short or the animal tied very long. 
Both cows and mares repeatedly give birth to young, while tied 
by the head in a stable with a number of other animals, and are 
usually unharmed. 

Some writers claim that the mother should be able to get to 
the fetus at once, in order to release it from its membranes, but 
clinically this is at least unimportant, if not untrue, and it is 
doubtful if the cow or mare ever saves the life of her fetus by 
quickly removing the fetal membranes from its nostrils so as to 
permit it to breathe. Admittedly, it is important that the mother 
538 



Management of Normal Parturitioji 539 

be allowed to cleanse her fetus thoroughly by licking and fondling 
it as soon as she has recovered from the exhaustion incident to 
labor. A danger of great importance, in cases where animals are 
tied by the head in a stable with other animals, is that the fetus 
may blunder into an adjoining stall and, especially a foal, may 
be seriously injured by coming within reach of other horses, 
which may kick, bite or trample it. With other domestic ani- 
mals, especially with the cow, this danger is not so great, although 
present in a minor degree. 

It is not always desirable to remove pregnant females too far 
from their usual place and surroundings at the time when they 
are to give birth to young, because in many of them it tends to 
induce a nervousness and unrest which may lead to more or less 
serious difficulty. Some animals, especially mares, become very 
nervous and even frantic when, removed from their companions 
and placed in a strange stall. This should be avoided. 

The stall in which an animal is to give birth to young should be 
ample in size and scrupulously clean. It should be well-bedded 
with as clean bedding as it is practicable to obtain. It should be 
kept quite free from feces and accumulations of urine and other 
decomposing substances. In case of a highly valued animal, it 
may even be desirable and economic to keep the stall and bedding 
disinfected in order to avoid the important and dangerous infec- 
tions to both fetus and mother which may follow a normal case 
of parturition. 

The best place in which a herbivorous animal may give birth 
to young is the open field or pasture, if the weather will permit, 
there being no place so safe from mechanical accident or from 
infection. In some cases complications arise which to some de- 
gree decrease the advantages to 5'oung of birth in the open pas- 
ture. During the hot summer months flies offer considerable 
annoyance and have special dangers as infection bearers for the 
mother and young when the act of birth takes place in the open 
field. 

The care of the pregnant animal during labor should not be of 
a kind which will in any way annoy or disturb her. When the 
animal is of material value, it is well that the course of labor 
should be sufficiently watched in order to determine whether it 
is proceeding regularly or not, since it is always important that, 
if help must be extended to .an animal, it should be early. A 



540 Veteri)iary Obstetrics 

great many pregnant animals resent the constant presence of 
persons during labor and become very nervous when too much 
attention is paid to them. Owners of mares have frequently noted, 
especially in those pregnant for the first time, that labor seems to 
set in when the watcher is away and not during his presence. . 
The animal sometimes seems to await a favorable moment to 
begin labor, so that, when an intended constant watch is set, 
labor is liable to not begin until some slight intermission in the 
supervision occurs, when it at once takes place. When the 
watch is resumed, it is found that birth has taken place during 
the interval. The watch upon an animal should therefore be 
barely sufficient to guard against any serious accident. 

In the care or watching of an animal during parturition, the 
breeder or his employees should be instructed as far as may be 
necessary, by the veterinarian, in reference to what constitutes 
the normal progress of parturition and when it is necessary to 
interfere in a case. Should the veterinarian be called to attend a 
case of what is suspected as irregular or abnormal parturition, he 
should determine by a careful examination the exact state of 
affairs and interfere only in those cases where there is some devia- 
tion from the normal which, in his judgment, it is best to correct, 
or which would not be ultimately and safely overcome by the 
mother alone. 

He should determine if the labor pains are normal and whether 
the general condition of the mother is good. He should deter- 
mine whether the genital passages of the mother are in normal 
condition and are dilating in a natural manner. The position of 
the fetus should be learned and the veterinarian should know if 
it will probably be expelled without assistance. 

The veterinarian should determine if birth maj^ properly take 
place at once or if in the natural course of events it should be de- 
layed for a period of time. For this purpose it is essential to 
differentiate between false, or preparatory, labor pains and real 
expulsive efforts designed to bring about the immediate expul- 
sion of the fetus. As we have suggested in preceding chapters, 
there may be premonitory pains indicated by some degree of un- 
easiness or slight colic symptoms, especially in the mare, some 
days prior to parturition. These should not be mistaken for par- 
turition itself and the expulsion of the fetus hastened b)' artifi- 
cial means, but the veterinarian should advise patient watching 



Mavagenient of Noj'vial Partimtion 541 

until labor sets in normally. In such cases, however, it would 
be still more unfortunate to overlook some essential and funda- 
mental difficulty which is preventing normal labor and which 
must eventually be overcome in order to save the life of the 
mother or fetus, or both. For example, in cases of torsion of 
the uterus, effective or vigorous labor pains do not occur 
because the conditions of the uterus are such as to prevent 
them.- It would be exceedingly unfortunate and perilous to the 
lives of both mother and fetus to pass over this displacement of 
the uterus without recognition of its character, because a few 
days or even hours of wait may lead to difficulties which are 
insurmountable and which could readily have been remedied at 
the right time. In cases of the bi-cornual development of the 
fetus in the uterus of the mare, we are not likely to observe very 
pronounced and vigorous labor pains, and yet each hour that is 
permitted to pass makes the obstacle which is to be overcome 
more and more difficult and renders the death of both mother 
aud fetus all the more certain to occur. 

In other cases, as in the cow, where the cervix of the uterus is 
very long and dense aud where its canal dilates very slowly, it 
is unwise to be hasty when it is possible or probable that, with a 
little patience and watching, the dilation will occur normally and 
the fetus be born alive without assistance. On the other hand, 
it is equally unwise to delay the dilation of the os and the ex- 
traction of the fetus if the conditions which are present clearly 
indicate that a natural dilation will not occur. Take, as an 
example, a case of rigidity or constriction of the cervix uteri 
observed by us, where a cow was allowed to go for some 10 
weeks after the normal end of gestation with a fetus imprisoned 
within the uterus and undergoing putrefaction ; here it is evi- 
dent that surgical interference should have occurred at the end 
of gestation, when it was noted that portions of the afterbirth 
had protruded beyond the vulva. 

So long as the act of parturition seems to be progressing 
favorably, the caretaker of the animal should not in an}' way in- 
terfere. Owners of breeding animals should be carefully in- 
structed by the veterinarian as to the dangers of unnecessary 
interference in cases of normal parturition. If the presence of 
the owner causes the animal to be nervous or irritable, he should 
remain at a safe distance until his services are required. On the 



542 Veterinary Obstetrics 

other hand, it must be constantly borne in mind that the well- 
being, or even life, of the mother and fetus may depend upon 
prompt aid from the owner or the attendant, of a kind which is 
too pressing to await the arrival of the veterinarian. 

This applies with special force to the mare, where timely aid 
may preserve the life or value of the mother or the fetus, when 
the veterinarian could not possibly accomplish the same end later. 
It is a general rule, which we might almost say is merely em- 
phasized by the few exceptions, that a veterinarian never saves 
the life of a foal in a case of dystokia, so abrupt is labor in the 
mare and so quickly does the foal perish because of the early 
separation between the fetal and maternal placentae. It is, there- 
fore, highly important that the owner or caretaker of breeding 
mares should be competent to give first aid in cases of parturition 
and it is a part of the duty of the veterinary obstetrist to instruct 
the owners of such animals, so far as it may be practicable, in 
these matters. 

We might illustrate this by citing some of the common acci- 
dents of parturition in the mare. In some cases an extremity be- 
comes pushed up against the roof of the vagina and into the 
rectum, so that a portion of the fetus may begin to protrude 
through the anus, still covered by the tissues between the two 
organs. If the owner promptly pushes these parts back and 
directs them properly in the genital passage, birth occurs safely 
and perhaps a living foal is produced, but a few minutes' 
delay leads to the rupture of the perineum and the virtual de- 
struction of the value of the mare. In another case a fetus pre- 
sents in an almost normal position and the nose or a foot becomes 
impacted against or caught upon the pelvic inlet. If the owner 
intelligently releases the part and gives it proper direction, the 
foal is born alive without further difficulty, but if it is allowed to 
go without this slight aid until a veterinarian has been called, 
the deviation of the part has then become much magnified, the 
life of the foal has been sacrificed and that of the mare more or 
less seriously endangered. 

The genital tract, at this time, is in an exceedingly receptive 
state for infection, and consequently the veterinarian, owner or 
other person attempting any examination or manipulation should 
be exceedingly careful regarding cleanliness and the prevention of 
infection, and no examination should ever be undertaken except 



Ma7iagement of Normal Parturition 543 

it is first warranted b}' the apparent course of labor, which, after 
proper watching, seems to indicate the possibility of the presence 
of some obstacle to normal parturition. 

The character of the labor pains should be observed and it 
should be determined if they are normal or otherwise. The 
labor pains may show a somewhat violent and clonic character, 
accompanied by inefficiency instead of that deliberate vigor 
which should accompany the act. This is claimed to occur 
chiefly in young and nervous animals, especially in primipara, 
and is due in all probability to the rather excessive pain accom- 
panying the first uterine contractions and the very slow dilation 
of the OS uteri and the genital passages. Under such conditions, 
any precipitate expulsive eifort causes unusual pain to the 
mother and leads her to desist early in the effort, so that the 
labor is not marked by the expected efficiency. There is usually 
little need for interference. If the patient is kept quiet and al- 
lowed a little time, the labor pains .soon acquire their normal 
vigor and accomplish the end without assistance. 

It has been claimed that, in some cases, the cervix uteri is in a 
state of spasm, and that this may be quickly overcome by apply- 
ing a little extract of belladonna to the parts. Other remedies 
of various kinds have been suggested, but clinically it cannot be 
demonstrated that any of them possess material value, and they 
probably in reality retard parturition, rather than help it, by 
simpl}' serving as a source of annoyance to the animal. It is 
extremely doubtful if the application of belladonna to the cervix 
will cause it to relax. Fleming states that contractions of the 
uterus, in some of these cases, are reversed and that they begin 
at the cervix of the organ and pass toward its fundus, a sort of 
anti-peristalsis, thus tending to force the fetus toward the apex 
of the horn rather than toward the vagina. Upon what clinical 
or experimental evidence such a theory depends, he is wholly 
silent. 

Some authors have emphasized the common clinical fact that 
easy parturition in the cow is more liable to be followed by par- 
turient paresis than is a protracted birth. The connection be- 
tween easy birth and parturient paresis is not fundamental nor 
essential, but simply coincident. Parturient paresis occurs be- 
fore birth and during labor, so that the easy accomplishment of 
the act cannot serve as a cause. Clinically, difficult labor serves 



544 Veterinary Obstetrics 

as a bar to subsequent parturient- paresis, but it does so indirectly, 
in a manner which we do not comprehend because we have not 
yet succeeded in fully defining the disease itself. 

Prolonged labor of every degree may occur in a way which pre- 
vents us from drawing any fixed line of demarcation between 
normal and abnormal birth. What may be an abnormal duration 
of labor in one species of animal may be wholly natural in an- 
other ; what may constitute abnormal birth in one animal of the 
same species may be wholly normal in another animal ; or that 
which may be normal in a given individual at one birth may be 
wholly abnormal at another birth. We have already suggested 
that in the mare the duration of labor is usually but a few min- 
utes, while in the cow it is from two to ten times as long, and 
may endure from two to four hours or even longer and j'et run 
an apparently normal course without material danger or incon- 
venience for either the mother or the calf. It is constantly to be 
borne in mind that in primipara, where the genital passages have 
not previously been dilated by a birth, the dilation is slow as 
compared with animals which have previously given birth to 
young. If a heifer has been in labor for several hours and the 
cervix of the uterus is not fully relaxed, but the position of the 
fetus, its size and condition, and the character of the birth canal 
itself, all seem to be normal, there is no reason for great anxiety 
and we had best await the efficiency of nature to accomplish the 
desired result. 

If animals are debilitated, whether from old age or inefficient 
feeding or care, they may be unable to normally give birth to 
young, although the fetus is in every way properly presented 
and the general condition of the genital organs is apparently nor- 
mal. Heifers which are bred very young are liable to become 
weak and emaciated on account of the extra burden placed upon 
their nutritive systems by the pregnant condition, and thus arrive 
at the period of parturition in an enfeebled state. In addition 
there may be a relatively large fetus. 

In such animals labor pains may be wanting in vigor and eflSl- 
ciency and after a time may more or less disappear and eventu- 
ally wholly cease. The uterine walls are so lacking in vigor, in 
harmony with the general debility of the system, that they be- 
come exhausted and their force diminishes or ceases. The feeble 
pains may rupture the fetal membranes and permit the gradual 
discharge of the fetal fluids. 



Management of Normal Parturition 545 

When it has been determined that there is a want of contractile 
power, although not dependent upon some mechanical obstacle to 
parturition, we have passed the border line between normal birth 
and dystokia. Without materially invading the latter field we 
may here suggest that the difficulty should be overcome by admin- 
istering such stimulants or tonics as will tend to arouse the con- 
tractile power of the uterus and the general strength of the ani- 
mal. Some have advised the use of ecbolics, such as ergot, rue and 
other drugs of this class, but their power to induce contractions 
of the uterus in domestic animals is very questionable, and 
they certainly do not tend to strengthen the system of the animal 
as a whole. It is probably better to employ such reliable stimu- 
lants to the nervous system as strychnine, or diffusible stimulants 
like alcohol and its derivatives, or coffee and other drugs. 

Traction upon the fetus is evidently unnecessary in normal 
parturition and is only called for in those cases where there is 
some deviation from the normal course. It is well here merely 
to point out that, in some of those cases which mark the border- 
line between normal birth and dystokia, it may be desirable to 
apply more or less traction in order to aid the pregnant animal 
in her efforts to expel the fetus. Such aid should be intelli- 
gently applied in those cases where the pregnant animal is some- 
what weak or debilitated, where for any reason the parturition 
has been more or less delayed and the animal is becoming ex- 
hausted, or where the life of the fetus may be imperiled by a 
tardy delivery. In primipara, especially in young heifers, gen- 
tle and judicious traction upon the fetus is frequently desirable 
in order to aid them in overcoming the obstacles presented, but 
it should always be borne in mind that any undue or unnecessary 
traction may prove exceedingly harmful by forcing the fetus 
through the birth canal before the latter has had time to become 
fully and effectively dilated. In this way the tissues become 
more or less seriously bruised or ruptured, which might well be 
avoided by allowing abundance of time and a natural dilation of 
the passages. 

When a fetus presents posteriorly, especially in the mare and 
cow, it is essential to hasten its expulsion as soon as the body 
has advanced far enough into the canal that the umbilic cord 
is engaged and compressed between the fetal body and the pubic 
brim of the mother. In managing such a case, the advancement 
35 



546 Veterinary Obstetrics 

of the fetus should be very deliberate and not hurried until the 
buttocks of the young animal have appeared at the vulva and 
have passed through it, thus dilating normally the entire length 
of the passage. Then, when the critical moment has arrived, 
the fetus should be prompth^ and carefully withdrawn in order 
that it may not be suilocated. 

It may be highly' important to determine in a given case if the 
fetus is alive or dead, because in a case of dystokia the question 
of embryotomy may arise and, if one is so unfortunate as to 
badly mutilate a fetus and then extract it from the mother in a 
living condition, especially if it is highlj' valued by the owner, 
the error ma}' become verj' embarrassing. 

It is frequently very difficult during labor to determine whether 
the young animal is alive or dead, especially when it is firmly im- 
pacted in the pelvis, where it has no power to move and no op- 
portunity to breathe or to show other definite signs of life. Flem- 
ing has asserted that fetor of the liquor amnii may not neces- 
sarily show that the fetus has perished. Upon what grounds 
such a statement is based we cannot comprehend, unless it be 
that, because there is an odor present, it is called fetid. The 
fetal fluids have a very marked and distinctive odor, which to the 
experienced obstetrist has no suggestion of fetor, but is simply 
the normal odor of a healthy liquid. In our experience, when 
the fetal fluids are fetid there is no longer reason for doubt that 
the fetus is dead, though admittedly the line of demarcation be- 
tween a non-fetid and a fetid state of the fetal fluids is not always 
easily drawn. Any active movements of the fetus establish 
clearly that it is living. 

When the fetus presents anteriorly, with the head protruded 
through the vulva, and remains incarcerated for some time, the 
head becomes engorged and swollen, the tongue swollen, blue- 
black and protruding from the mouth, and the eyes glassy and 
insensible. However, the conclusion is not to be hastily drawn 
that it is dead ; on the other hand, it may be very much alive 
and recover immediately and begin to move as soon as it is re- 
leased from its perilous position. In fact, such engorgement of 
the head and cyanosis of the visible mucosa show that the fetus 
was alive when the head appeared. Had it been dead at the 
beginning of labor, the engorgement could not have occurred. 



Management of Normal Parturition 547 

In the mare, however, it ma}- general!}- be considered that, if 
vigorous expulsive efforts have continued for two or three hours, 
or if the fetus has been engaged in the pelvis for even a half 
hour, unless we can observe some definite sign of life, the foal 
has already perished. 

The death of the fetus, some claim, retards parturition, and 
the claim is apparenth' justified bj- clinical experience. 

The contractions of the uterus upon the living 3-ouag tend to 
cause the latter to make spontaneous movements and, in doing so, 
to extend its extremities in the most favorable position for their 
passage through the birth canal. If dead, this extension of the 
limbs is not likelj- to occur, because of the absence of reflex 
movements and of the rigidit}- of the foal. Some authors state 
that the death of the fetus tends to eliminate a certain stimula- 
tion to the uterine walls, which causes their contraction, but this 
is not verified clinically because, as a general rule, we see just as 
vigorous expulsive efforts in case of a dead fetus as in a living 
one. Others contend that the contractions of the uterus are not 
effective upon the dead fetus, because of the flaccid condition of 
its tissues. 

As previoush- stated, the position of the fetus prior to birth is 
essentially different from that which it is expected to assume 
during its expulsion. Saint-Cj-r is correct in holding that, if the 
dead fetus presents in a proper position, the expulsion is as easj- 
as though the young were alive. Of course, if the fetus has 
undergone partial decomposition and is emphysematous, its ex- 
pulsion is ver}- much more difficult. 

The causes of the death of the fetus during the period of labor 
may be exceedingly varied. The umbilic cord of the human 
fetus sometimes becomes knotted, or it maj- twist about the neck, 
bod}- or limbs of the child, and thus interrupt the circulation and 
cause its death. This does not occur in domestic animals with 
suflEcient frequency' to become of clinical importance. The um- 
bilic cord is too short to favor such an accident. 

Fleming claims that the death of the fetus may be due to the 
premature rupture of the membranes, the escape of the fetal 
liquids, and the consequent immediate pressure of the uterus upon 
the fetus. We do not understand how the pressure of the uterus 



548 Veterinary Obstetrics 

upon the fetus can be any greater after the expulsion of the fetal 
liquids than before, although we admit that it does closely in- 
vest the fetal body and may thus be prevented from expelling 
the fetus from its cavity. The escape of the fetal fluids indi- 
cates rather a delayed expulsion of the fetus than a premature 
rupture of the membranes ; that is, the membranes normally 
rupture, but after their rupture some mechanical obstacle or 
some weakness of the uterus has served to prevent the expulsion 
of the fetus, and consequently has led to its death. 

Indirectly the rupture of the fetal membranes and escape of 
the fluids is probably the most common cause of the death of the 
fetus during labor. The fact that a foal does not usually live more 
than one to three hours after the first expulsive efforts, while 
the calf may continue to live much longer, is explained by the 
differences in the character of the placentae. The attachments in 
the mare are less intimate and become detached very shortly after 
labor sets in. The calf lives longer largely because the os uteri 
of the cow dilates more slowly and hence the fetal waters do not 
so completely escape, or they may be entirely retained and the 
membranes remain unruptured for a considerable period of time. 
In the cow also the allantoic sac may not rupture at first, but 
only the amnion, whereas in the mare the allantoic sac must 
necessarily rupture before the amniotic sac appears at the vulva 
and, consequently, when this latter ruptures both sacs are freely 
open and all the fluids may escape. The escape of these fluids 
permits a contraction of the uterus which certainly exerts an 
important influence upon the dehiscence of the placenta and 
leads to the death of the fetus. 

****** 

The rupture of the water-bag in an approximately normal par- 
turition may well be left wholly to nature, as it ordinarily requires 
no interference, but, on the other hand, is usually better accom- 
plished without it and will naturally occur at the most appropri- 
ate time. The water-bag cannot protrude far bej'ond the vulva 
in the cow or other ruminant, without rupturing, because the 
amnion is adherent to the chorion over a large part of its area, so 
that it cannot pass out with the fetus, but must rupture, and the 
fetils be born naked. 

Some writers claim that it is at times necessary for an attendant 
to rupture, or even to cut the chorion of the new-born. We 



Management of Normal Parturition 549 

have not had occasion to observe any such necessity. A living 
foal cannot be born in the chorion, because it would necessarily 
die from asphyxia before it could possibly be expelled. It would 
then be useless to open the chorion. 

The expulsion of an aborted fetus in all its membranes is not 
rare, but the expulsion of a full-sized dead fetus enclosed within 
the chorion is improbable, if not impossible. Should such ex- 
pulsion be threatened, and the chorion protrude into the vulva, 
it should be opened to allow the fluids to escape and render the 
expulsion of the fetus easier. 

Occasionally the foal is born more or less enveloped in the 
amnion, but this is so delicate that a very slight struggle upon 
its part will free it from any adherent portions. It has also been 
stated that the mother gnaws through this membrane and releases 
the young animal, but she always rests for a time after the ex- 
pulsion of the fetus, and consequently, if its life were jeopardized 
by being expelled included in its membranes, it would become 
asphyxiated long before the mother would give it any attention. 
We have not known a fetus to perish because of inclusion within 
the membranes. 

It is needless to remark that, in cases where a living fetus is 
expelled more or less enclosed in the amnion in such a way as 
to interfere with respiration, the attendant should remove the 
obstruction as promptly as possible, preferably before the fetus is 
completely expelled. 



THE CARE OF THE PARTURIENT ANIMAL 
AND OF THE NEW-BORN. 

After the completion of labor, the mother should not be an- 
noyed by the presence of other animals of her own or other spe- 
cies, or by the unnecessary presence of persons. She should have 
clean and comfortable quarters, whether in the stable or in the 
field, and her body should be kept as clean as circumstances per- 
mit ; if present, any blood or discharges should be washed or 
wiped away from her tail and thighs or other parts of her body 
which have become soiled. In case of the large domestic ani- 
mals, the afterbirth, if it has come away, should be removed and 
destroyed, although, as a general rule, no material harm comes 
to the mother from eating it. If the animal is stabled, allowing 
the expelled afterbirth to remain in the stall permits it to un- 
dergo rapid decomposition, entices flies, and tends to render in- 
fection of the mother or fetus more probable because of its pres- 
ence. 

An abundance of good drinking water and suitable food should 
be allowed. For herbivorous animals, which have given birth 
to young during the warm season of the year, grass constitutes 
the most favorable diet. Mares which are used for work 
purposes should be rested for a few days after parturition, as a 
safeguard against disease. As a general rule the mare may 
safely return to work in the course of three or four days, if 
parturition has been easy and without accident, but the labor must 
be of a gentle character. 

If the genital organs have suffered any material injur}' during 
the act of birth, proper precautions should be taken against in- 
fection. For this purpose some mild disinfecting solution should 
be used to flush out the vulva and vagina. Unless these inter- 
ferences are necessitated by conditions, the animal should be left 
quite alone. 

Immediately following parturition there occurs a series of rapid 
changes by which the genital organs resume the form and func- 
tions of the non-pregnant animal. In domestic animals this 
interval is brief, usually extending over but three to five days, 
and is marked by little exterior change. It is a period in which 
the maternal body is highly susceptible to insults of various 
550 



Care of the Parturie7it Animal 551 

kinds and in which pathologic changes are very readil}' aroused 
in case of accident or undue exposure. 

Normally this interval of time passes almost unnoticed in our 
domestic animals, and it is only when we give close attention 
that the changes which are taking place are observed. 

After-pains in the domestic animals are unobserved as a natu- 
ral condition, beyond some expulsive pains, which are noticed 
in some cases while the afterbirth is being detached and ex- 
pelled. When this act is accomplished, we usually observe no 
pains, although Saint- Cyr claims that in some cases there is a 
whisking of the tail and an increased tension of the abdomen 
which indicates that the uterus is contracting in a manner to 
cause some pain to the animal. 

As a general rule, when evidences of abdominal pain follow 
shortly after parturition, they suggest some pathologic condition, 
which may be more or less important, such as the retention of 
a portion of the fetal membranes or some displacement, such as a 
beginning inversion of the uterus. Consequently, whenever 
such pains are observed following parturition, a careful manual 
exploration of the uterus should be made to determine the cause, 
followed by the application of the necessary remedies. 

After the expulsion of the fetus and its membranes, there in- 
evitably occurs in all animal^ a more or less recognizable dis- 
charge from the uterus, consisting of blood and fragments of the 
uterine mucosa or of the villi of the placenta, which substances 
need be cast off before the uterus can resume its normal state. 
This discharge is known as the lochia. Though prominent in 
woman, on account of the very complex discoid placenta, it is 
inconspicuous in animals, where the placentae are more extensive 
in area and less complex in their structure, so that one needs ob- 
serve an animal quite closely in order to recognize the presence of 
the lochial discharge following an easy birth. It becomes least 
conspicuous when the placenta is distributed over a wide area and 
has a feeble attachment to the uterus. It follows that, in the 
mare, where a diffused placenta is found, in which the villi are 
not very extensive, the lochia can scarcely be recognized at all, 
while in the cow with the multiple or cotyledonous placenta it is 
more evident, but even here, under normal conditions, quickly 
disappears. In the mare the lochial discharge should not be 
recognizable except after a few hours, nor should it be conspicu- 



552 Veterijiary Obstetrics 

ous in the cow for more than a day or two. At first it is a red- 
dish or grayish-red discharge, owing to the admixture of blood, 
but this quickly changes to mucus, which may persist for a longer 
period of time. 

Fleming considers this lochial discharge far more important 
than we have observed. He states that it may continue for 
days or weeks and that 7 to 8 quarts of lochial discharge have 
been removed from the uterine cavity of the mare three days 
after parturition. Apparently he and others have failed to 
recognize the proper line of demarcation between the physiology 
of the puerperal state and the pathology of this period. In our 
judgment, when these discharges become very apparent and 
acquire marked characters they are no longer physiologic, but 
are pathologic, and should be regarded as such. 

The discharge of the lochia is of physiologic importance to 
the animal, since it rids the maternal system of an amount of 
tissue which has ceased to live and which must consequently be 
excreted either directly through the vagina or indirectly by be- 
ing absorbed by the maternal system and later excreted through 
other channels. If it is not promptly discharged, it forms a 
dangerous culture medium in which bacteria may multiply and 
cause more or less serious disease. 

Some believe that the suspension of the lochial discharge 
causes serious di.sease. This is difficult of proof. Admittedly 
we observe serious disease in animals when the lochia become 
infected and the products of infection enter the maternal system. 
This is not the result of lochial suspension, but of infection. 

Often the mother more or less resents the approach of other 
animals or of persons and is very liable to injure her young by 
treading upon them in an effort to protect them. Such danger 
is often observed with nervous mares. The same is especially 
noted if a sow is disturbed. She then shows great liability to 
trample her young, or, failing in this, she lies upon some of the 
pigs as a consequence of her excitement. 

It should not be forgotten that many of our domestic animals 
are prepared to strenuously defend their j'oung and will vigor- 
ously attack other animals, or man, when they approach. Such 
an attitude is not confined to any one species, but is a maternal 
instinct which is shown to some extent by all animals which 



Care of the Parturient Animal 553 

naturally fight in self-defense. It is very common in the mare, 
and in many cases it is more or less dangerous to approach her 
when she is giving her first attention to a new-born foal. Not 
only may she trample the foal, but may bite, strike or kick a-ay 
person who approaches her. A mare resented strongly the 
actions of an attendant, who had placed his arms about her 
foal in order to move it from one enclosure to another. In 
an effort to defend the foal she kicked so vigorously at the 
attendant that, striking instead the head of the foal, she killed 
it instantly in the attendant's arms. It is consequently discreet, 
when one wishes to handle a new-born foal, to have a second 
party present to control the mare and thus avoid accident, until 
her attitude has been fully determined. We note a similar de- 
gree of danger in approaching cows with new-born calves, espe- 
cially those which have been allowed to run at large during most 
of their lives and have acquired a rather strong sense of self- 
defense. The danger of approaching a bitch with new-born 
puppies is very well known and should always be recognized. 
The sow habitually and vigorously defends her young and some- 
times imperils the life or limb of any attendant who may injudi- 
ciously approach her. 

In some instances the mother fails to show any maternal affec- 
tion for her young, will repel it, not allow it to suck, nor take 
any care of it, and may instead destroy it because of its attempts 
to approach her. In such instances some writers suggest various 
expedients to induce the mother to permit the young to suckle 
or to cause her to care for it, but as a rule these efforts are not 
highly successful if the repulsion is well marked and strong. 
In some cases it may be that attendants can quiet the mother, 
and, by carefully bringing the young animal in contact with her 
for a time, overcome her repulsion. Frequently such refusal of 
the mother to own and care for her young is referable to interfer- 
ence and annoyance by attendants. 

Multiparous animals sometimes give birth to more young than 
the mother has teats, in which case the supernumerary ones usu- 
ally perish. In the sow and other multiparious animals each 
young has its own particular teat, to which it regularly goes at 
feeding time. The sternal teats of the sow are generally better 
developed and supply more milk, and the most vigorous young 
usually take to these teats and crowd the weaker ones to those 



554 Veterinary Obstetrics 

glands which supply the lesser amount. In this way it fre- 
quently^ occurs that one or more of the pigs is very poorly nour- 
ished. It has been suggested that these weaker individuals be 
put upon the larger teats, but this is not a very easy process to 
carry out, since the selection of the teats is generally made by 
the pigs themselves and adhered to quite vigorously. When 
there are more young than there are teats present, the excess 
should be destroyed, reared by hand or placed upon another ani- 
mal. The latter plan is most convenient, but does not always 
succeed, because the foster mother will not always allow the 
young animal to suck. 

Sometimes, wheji several animals of the same species, with 
young, are kept in the same enclosure, the older or stronger young 
animals maj' rob the j'ounger ones of food by sucking not only 
their own mother but also that of their younger neighbors, and 
being stronger can readily push them away from the teat. Such 
an occurrence should be watched for and the needed measures 
taken to insure the 3'ounger animal its normal food supply. 

The identification of the new-born young of a given parent 
sometimes offers serious difficulty, and the veterinarian should be 
in as good a position as possible to aid owners in escaping from such 
a dilemma. When females of the same species give birth to young 
at about the same time and in the same enclosure, their offspring 
may become interchanged. The young of one may be stolen by 
another mother, and considerable confusion thus brought about. 
Sometimes an animal which has not yet given birth to young 
may take the young of another animal and suckle it and drive 
away the actual mother. One case, which we observed, raised a 
serious question as to pedigree. A client owned a valuable herd 
of pedigreed draft mares, among which there was a grade draft 
mare of very low value. Our client, upon going to the pasture 
one morning, found a very excellent foal being cared for by the 
cheap grade mare. The disparity between the form and quality 
of the foal and what he would expect from the inferior mare was 
so great that his suspicions were at once arou.sed. In the same 
enclosure was one of his best pedigreed mares, which looked as 
though she had foaled, although there was no great evidence 
and there were scarcely any traces of blood or fetal fluids upon 
the tail or thighs. On the other hand, the grade mare had her 
tail and thighs badly soiled and portions of the afterbirth were 



Care of the Parturient A^iimal 555 

hanging from her vulva. Under the circumstances, I was asked 
to aid in solving the problem. Upon examination, it was found 
that the valuable mare had indeed given birth to a foal and that 
her uterus was vacant, while, upon examining the grade mare, 
it was found that her foal was lying dead in her uterus. It thus 
became clearly established that she had stolen the foal of the ped- 
igreed mare. 

^ ^ ^ % ^ ^ 

In other cases the mother, owing to some abnormal appetite, 
proceeds to destroy her j'oung and eat them. This is especially 
notable in the sow, which will not infrequently eat her 
entire litter of pigs shortly after they are born. In some in- 
stances this abnormal appetite or cannibalism does not confine 
itself to one mother, but seems to involve an entire herd of sows 
during a given season, so that the pig crop on a given farm may 
be utterlj' destroyed by this perversion of the maternal instinct. 
The causes of this perversit}' are not well understood. It occurs 
most frequentl}' in those sows which are kept in styes, but some- 
times also in those which run at large. In individual cases it 
would seem to be due sometimes to the accidental death of one 
or more of the young, followed by the eating of it by the mother, 
in conformity with her general omnivorous character. Once 
having tasted this flesh, she may proceed to kill and devour the 
others, but this does not account for the wholesale perversion 
which is sometimes observed. 

In one instance coming to our knowledge a herd of ewes de- 
voured their new-born lambs with great uniformity, so that the 
entire lamb crop of a given year was virtually destroyed. We 
have also observed the cat devour her new-born kittens. 

In these more rare cases we can only attribute it, in the pres- 
ent state of our knowledge, to some general defect in the care of 
the pregnant animals at the time of their giving birth to young 
or shortly preceding. It might be well to try, in such instances, 
the changing of the animal's food and the allowance of some al- 
terative, such as an increased ration of salt or the administration, 
in the food, of alkalies, like bicarbonate of soda. 

Harms recommends, as a remedy for sows which devour their 
young, that they be watched during parturition and the fetal 
membranes be removed so that they cannot eat them and thereby 



556 Veterinary Obstetrics 

arouse their appetite for eating their young. He suggests, in 
addition, that she be given veratri radix, and cites Vogel as recom- 
mending 0.3 to 0.5 grammes given internally, while Harms pre- 
fers to take a small piece of the root cut in the form of a wedge 
and insert it beneath the skin of the animal. Others suggest 
that vomition be induced by administering tartar emetic, or that 
opium or camphor be given. Harms also cites Professor Landois, 
who mentions an instance of a sow which showed a tendency to 
devour her young and was cured of the habit by sorcery. In 
this instance a local expert repeated a series of words for 100 
consecutive times, stroking the sow over the head, and thereafter 
she showed no further tendency to eat her young. As Harms 
very well remarks, however, the best known remedy for these 
animals, in which the vice has once occurred, is to fatten, and 
send them to the butcher. 

The new-born usually gets the best care from its mother, when 
she has been given natural and proper environment in which to 
bring forth her young and the birth has been normal. So far as 
is practicable, the care of the young should be left to the instinct 
of the mother, but the conditions of domestication impose cer- 
tain dangers and risks to the new-born which intelligent care 
upon the part of the owner may minimize or obviate. 

It is essential to an intelligent consideration of the question to 
bear in mind the changes in environment and function which 
must occur when the fetus is expelled from the uterus and must 
begin its extra-uterine life. Certain functions which have pre- 
viously been carried on through the medium of the placenta of 
the mother must now be taken up by the young animal itself in 
a semi-independent manner. It is the safe establishment of these 
functions which constitutes the chief concern to the owner. 

I. Prior to birth, the supply of oxygen for the fetus has been 
carried from the lungs of the mother to the maternal placenta and 
thence to the fetus, while the carbon dioxide and other waste or 
injurious substances have been carried from the fetal circulation 
through the fetal placenta, and thence through the circulation of 
the mother, to be excreted from her lungs or other organs. This 
relationship has become suddenly interrupted by the act of birth 
and must quickly be replaced by direct respiration through the 
lungs of the new-born animal. The urgency for the establish- 
ment of this respiration is such that it permits no delay. The 



Care of the New-Born Atiimal 557 

first object, therefore, of a care-taker or watcher of new-born ani- 
mals is to see that they begin breathing promptly and that any 
impediments to this act are removed as quickly as possible or that 
any other necessary means which might insure the prompt estab- 
lishment of respiration are employed. 

It should be immediately seen that the nostrils of the fetus are 
free, so that air may readily enter the lungs ; if portions of the 
fetal membranes cover the nose they should be removed ; if mu- 
cus has collected in the nostrils, it should be taken away prompt- 
ly. In a litter of new-born pigs we noted that there was difficult 
respiration, although the nostrils were not blocked. Upon post- 
mortem examination of some of these, we found that a clot of 
firm mucus was lodged in the larynx. It is quite possible that 
such a condition sometimes exists in other young animals, and 
should have the attention of the care-taker. In many cases, per- 
haps, this mucus could be dislodged by manipulating the tongue — 
by alternately drawing it forward and then allowing it to retract. 

In some cases the fetus has apparently been strangled to some 
extent during bijth, owing to the inhalation of fluids because of 
interruption of the umbilic circulation, in which instance it may be 
advisable to drain out some of the fluid by suspending the young 
animal for a few moments by the hind legs or by placing it in a 
position with its head declined. If, however, the fetal circula- 
tion is good, any fetal fluids which may have been inhaled are 
promptly absorbed and cease to have danger for the young animal. 

In tardy birth there may occur suspended animation because 
of a too long delayed respiration. According to some writers, 
the principal .stimulus in establishing respiration is the shock 
which the new-born receives from being expelled from the uterus, 
where the temperature has been 105 to 108 F., to the exterior, in 
the cold, dry air. The importance of this in the arousing of 
respiration is not very clear clinically, and there seems to belittle 
difference in this respect whether a fetus be born where the 
temperature is at zero F, or 90 to 100° F. It seems, how- 
ever, that the dashing of cold water upon the fetus or vigorous 
stroking of the chest will arouse the act of respiration in some 
cases. Generally, we should probably attribute the induction of 
respiration to the reflex influence of the venous blood upon the 
central nervous system. In order to arouse" this reflex, it may be 
of advantage to place the animal with its head in a declining 



558 Veterinary Obstetrics 

position or to pick the fetus up by the hind feet for a few 
moments. 

Artificial respiration ma}' also be induced by the usual com- 
pression and relaxation of the chest walls, or by inflating 
the lungs by forcing air through the nostrils with a small bel- 
lows, should such an apparatus be at hand. So long as the 
heart continues to beat, there is a possibility of inducing respira- 
tion, and efforts should consequently be continued, so long as the 
cardiac action persists. As a general rule, respiration cannot be 
established at all unless it succeeds very promptly, so that in 
those cases where the animal does not breathe within two or 
three minutes it will probably die in spite of the fact that the 
heart may continue to act for lo or 15 minutes. 

2. The umbilic cord must be divided and the last direct rela- 
tion between the mother and young severed. This division re- 
sults in a wound which involves the arteries, veins and urachus, 
each of which communicates with internal parts of the system of 
the young animal. Different writers assume different attitudes 
toward the care of the navel of the new-born. Naturally, the 
umbilic cord becomes ruptured in a variety of ways. In the 
foal the cord is so long (3 feet) that it is usually not ruptured 
when the fetus is expelled, if the mare is recumbent, but gives 
way only when she rises to her feet, and even then in some cases 
not until she turns her head toward the fetus in order to care for 
it, and in so doing pulls the cord in two near the umbilicus. In 
other cases, in the mare, the chorion becomes detached from the 
uterus almost immediately after the expuLsion of the fetus and 
comes away with the cord still intact. It is then ruptured later 
by the struggles of the fetus itself. The mare maj' step upon 
some portion of the membranes when the foal is attempting to 
get up, and the foal, in falling, throws its weight upon the cord 
in such a way as to rupture it. 

In the cow the umbilic cord is very short (about 12 to 15 
inches) and is almost always ruptiired just as the fetus emerges 
from the birth canal, or even slightly before. In carnivora and 
the sow the umbilic cord is frequently not ruptured in a spon- ■ 
taneous way, but is torn in two by the teeth of the mother. 

The point at which the navel cord naturally ruptures or is 
divided by the mother corresponds quite closely in all our do- 
mestic animals. In examining the navel cord of the foal, we 



Care of the New-Bo)'n Ariimal 



559 



find that immediately against the umbilicus there is a dense area 
extending for a distance of about i]4 inches, which ends some- 
what abruptly by a marked ring in the soft umbilic cord. This 
projection, A, Fig. 90 B, consists of a hairless skin, which, in the 
healing of the navel, atrophies and disappears. In the calf, the 
corresponding cutaneous navel is haired and persists for some 
months as a conical projection of skin, thickly covered with long 
hairs. Just beyond this point, one or two inches from it in the 
foal, is the weakest point in the cord, and it is at this point that 
it ruptures or is torn in two. 




Fig. 90 B. Umbilic Cord of Foai,. 
A, Cutaneous portion of cord. B, Amniotic portion of cord. 

After it ruptures, the behavior of the parts when left undis- 
turbed is interesting and highly suggestive of the degree and 
character of interference demanded upon the part of the attend- 
ant. One of the most prominent effects of the rupture of the 
cord by linear tension or b)' laceration by the teeth of the mother, 
is the promptness with which hemostasis is brought about, so 
that as a rule there is but little hemorrhage, appearing usually 
to not exceed the amount of blood lying in the umbilic veins 
outside the umbilic ring. 



560 Veterinary Obstetrics 

The two fetal ends of the iimbilic arteries retract very 
promptly toward and into the abdominal cavity, and in doing so 
their cavities become decreased by the shortening and consequent 
thickening of their walls, which tend to close them completely 
and prevent hemorrhage. Additional security against bleeding 
arises from the fact that, in retracting, they must draw back with 
them the loose areolar tissue, which produces an impermeable 
net- work of fibers just beyond their broken ends. The result is 
well delineated at UA in Fig. 56, page 337. The ruptured um- 
bilic veins, after some of their contained blood has escaped, col- 
lapse and remain almost empty in the region of the umbilicus, 
although still partially filled with blood in their course through 
the abdominal cavity to the liver. 

The urachus is so intimately associated with, and attached to, 
the two umbilic arteries that it recedes into the abdominal cavity 
to some extent, along with the latter. The Whartonian gelatine 
surrounding the vessels in the cord loses almost its entire sub- 
stance by its liquid portions slowly oozing out from the broken 
surface of the cord, a process which is usually favored and accel- 
erated by the licking of the stump of the cord by the mother, 
which presses the fluid out by a sort of massage. 

Occasionally we meet with variations as to the promptness and 
exact position of the rupture of the umbilic cord. Cases have 
been recorded where it has given way immediately against the 
umbilicus, although these accidents are very rare and apparently 
accompanied by little, if any, danger. A more common devia- 
tion from the normal rupture of the cord is its giving way at a 
point too remote from the abdomen, so that in some cases we find 
the navel stump of the foal or calf 5 or 6 inches in length. This 
leads to two dangers. The extra length of the cord prevents the 
rapid escape of the Whartonian gelatine and also prevents the 
retraction of the umbilic arteries from the exterior ; infection 
and putrefaction occur in the cord, which may lead to an iii- 
flammation of the veins, arteries or urachus, and thereby greatly 
imperil the life of the fetus. In other cases, when the cord is 
too long, it may be trampled upon or become otherwise caught, 
and the fetus, in struggling, may tear it away too close to the 
umbilicus and make a fresh wound, inviting infection. 

Two apparently conflicting courses are advised by different 
veterinary obstetrists in reference to interference with the um- 
bilic cord ; without and with ligation. 



Care of the New-Bom Animal 561 

We very greatly prefer either to allow the cord to be ruptured 
naturally and go wholly without mechanical interference, or, in 
case of valuable animals where interference will not harmfully 
annoy the mother and young, to imitate and supplement nature 
with antisepsis and artificial dessication. If the cord has not 
ruptured spontaneously, or if the stump is too long, it is to be 
ruptured at the proper point by linear tension. The cord is 
grasped at the point where we desire it to be severed, with the 
thumb and index finger of each hand and, by drawing the hands 
apart, it is torn asunder between them. If the cord is too strong, 
we may facilitate the rupture with the thumb nail, or by scraping 
the cord in two with a dull scalpel. 

After the cord has been divided, the Whartonian gelatine and 
all fluids should be pressed out of the remaining stump as com- 
letely as possible, by grasping it close against the umbilicus, be- 
tween the thumb and finger, and then drawing downward, forc- 
ing the fluids out from the broken end. This operation is to be 
carried out under strict antiseptic precautions, and as soon as 
completed there should be applied a dessicating antiseptic powder 
which may consist of almost any reliable antiseptic of a character 
which will not prove caustic to the surrounding parts. We would 
suggest, as such an antiseptic, a powder compo.sed of equal parts 
of alum, tannin and oxide of zinc, or of equal parts of tannin and 
iodoform. 

A variety of antiseptics may be selected, according to the 
custom and habit of the practitioner. The essential point is 
thorough antisepsis and prompt dessication of the stump. When 
the navel heals under natural conditions, it dessicates and dries 
as a hard, black eschar in 24 to 48 hours afterbirth, which brings 
about a hermetic sealing of the wound and the vessels of the cord, 
and renders infection thereafter impossible. We simply aim to 
second the efforts of nature to bring about aseptic or antiseptic 
dessication of the stump. We advise the application of the dessi- 
cant antiseptic powder as soon as possible after birth, to be re- 
peated every hour or two until the dessication of the stump has 
become complete. 

Many veterinary obstetrists advise that the cord be ligated and 
then divided beyond the ligature ; others advise that two liga- 
tures be applied and the division be made between the two. 
Some suggest that the ligated fetal stump should be frequently 
36 



562 Veterinary Obstetrics 

washed with a liquid antiseptic and thus guarded against serious 
nfection. It is evident that, if these antiseptic solutions are 
applied with suflBcient frequency and thoroughness, they must 
accomplish their purpose of preventing putrefaction of the cord, 
with its accompanying dangers. 

This is neither so ef&cacious nor so convenient as the preced- 
ing plan. The presence of the ligature tends to prevent the re- 
traction of the stumps of the umbilic arteries, and keeps them in 
a position where they are far more exposed to the possibilities 
of infection. There is probably also an increased liability to 
hemorrhage, as viewed from the standpoint of clinical experi- 
ence. We have known but one fatality from umbilic hemor- 
rhage in the foal, and this was caused by, or at least occurred 
with, ligation and excision of the cord. We all recognize 
clearly the far greater tendency toward hemorrhage from an 
artery when it has been divided by cutting instead of by linear 
tension, scraping, or other kind of mutilation. If, in addition 
to this, the artery is not allowed to retract or its proper retraction 
is interfered with, the tendency to bleeding is greatly increased. 

lyigation of the umbilic cord by an ignorant layman or careless 
veterinarian is one of the most dangerous interferences with a 
wound known to surgery. Frequently the work is done with 
dirty hands, and a common cord is used without sterilization. 
Often the cord used is repulsively dirty. The Whartonian 
gelatin is imprisoned on the one hand by the ligature, on the 
other by the almost impervious amniotic sheath of the cord. 
The imprisoned fluid furnishes an excellent culture medium for 
decomposition bacteria ; the dirty hands of the operator, the 
dirty ligature, or flies attracted by the moist cord, furnish the 
infection and cause putrid decomposition of the cord, which 
should dessicate instead. 

The ligature detains the arteries, veins and urachus in the 
infected area, and eventually a more or less extensive infection 
occurs and there results a series of highly fatal maladies which 
we shall consider under " Infections of the New- Born." 

3. The urethra, anus and other external openings should be 
observed to see that they are normal. In case of abnormality 
it should be determined whether or not they require attention. 

4. It should be determined that the various excretions of the 
body are taking place normally. It must be learned that the 



Care of the New- Born Animal 563 

intestinal contents are being normally expelled. We are chiefly 
concerned with the discharge of the accumulated excretion in 
the intestines, known as meconium. Normally, this should be 
expelled very shortly after birth, which in some cases does not 
occur, especially in the foal, and as a result there soon appear 
symptoms of rentention of the meconium, which we shall consider 
later, among the diseases of the new-born. It is highly important 
that the care-taker should see that the meconium is promptly 
expelled, and if necessary its expulsion should be favored by 
means of enemas of warm water, warm normal salt solution, or 
soda bicarborate solution. The enemas should be continued 
until all hard pellets of meconium have come away and there 
follows instead a soft, pasty meconic mass. 

5. The young animal should be promptly supplied with nour- 
ishment. In the larger domestic animals, the need for early 
nourishment is important, and it is best that the young animal 
should receive a liberal supply of milk within an hour or two 
after its birth, since otherwise it suffers more or less from hunger. 
It is essential that the young animal is enabled to reach the teat 
and suck, or that milk be administered to it artificially. In 
herbivorous animals the mother always stands for the young to 
suck, and consequently it is necessary that the latter be able to 
stand or be assisted in standing, in order that it may reach the 
teat and procure nourishment. If for any reason the young 
animal cannot stand, milk should be drawn from the udder of 
the mother and given to it in sufScient quantity and at proper 
intervals. 

The young animal should not be allowed too much milk, how- 
ever, since it will frequently overfeed. This is especially true 
of the foal, which sometimes shows an inordinate appetite and 
seems to consider it incumbent upon it to take all the milk which 
the udder of the mother contains, and thereby seriously overfeeds, 
which may end in more or less severe indigestion. It is conse- 
quently advisable, in many instances, to Withdraw a portion of 
the milk for the first few days in order to prevent the overfeed- 
ing of the young foal, a danger which does not seem to exist to 
the same degree in other young animals. 

Some writers insist that it is highly essential for the young 
animal to receive from the mother the first milk, or colostrum, 
because, they say, this acts as a laxative and brings away the 



564 Veteriyiary Obstetrics 

meconium which has become accumulated in the intestinal tract. 
Clinicallj' this theory is apparently not so important as some per- 
sons would have us believe. The udder of the mare frequently 
becomes so distended that the milk flows out in large quantities 
for hours, days or even weeks before the birth of the foal. Yet 
this does not seem to have any very definite relation to the reten- 
tion of the meconium, although we would assume that the colos- 
trum has wholly disappeared before the birth of the foal. As 
the foal is born with the rectum impacted with hard masses of 
meconium, the condition is not acquired after birth through the 
absence of the colostrum, and we are unable to see clinically that 
the retention is any more probable or serious in the foal of a 
mare from which the colostrum has escaped than in those in- 
stances where the reverse is true. 

^ ^ ;|: H= * * 

The artificial feeding of the new-born has until recently 
been considered a difficult and uncertain task. The chief diffi- 
culty has been in reference to the question of intestinal infection 
because of contaminated food. The comparative composition of 
the milk from various species of animals has been well studied and 
understood, and attempts have been made in artificial feeding to 
modify the milk by the addition of sugar, water or other normal 
constituents in amounts which would cause it to approach ap- 
proximately the composition of that of the species to which 
the young animal belongs. Thus, in case of the artificial feed- 
ing of a foal upon cow's milk, the milk is diluted with 10 to 20 ^ 
of water, and sugar is added, in order to have it approach the 
composition of the milk of the mare. This is attempted under 
the assumption that the young of a given species thrives best 
upon the milk derived from that species, and next best upon a 
milk which has been artificially modified to closely resemble that 
of the mother of the new-born animal. This artificial change in 
the composition of milk has not produced the satisfactory results 
which, for a time, were expected and, although important, is 
not of the same value as the control of the bacterial contents of 
the milk. 

At present we place the chief emphasis in artificial feeding 
upon the question of having the milk, as far as possible, free from 
the presence of pathogenic bacteria. Hence it is aimed to keep 
the milk, and the vessels from wliich it is fed, scrupuously clean, 



Cai'e of the Neiv-Born Anitnal 565 

and to take ever}^ measure known to prevent its contamination 
with dangerous bacteria. Some advise the sterilization of the 
milk, while others are opposed to it. If the milk is clean and 
free from injurious bacteria, it is better for the young that it be 
given in the raw state ; but, if it is contaminated or if it comes 
from an animal which is suffering from an infectious disease, like 
tuberculosis, it is essential that the milk be sterilized before be- 
ing fed to the young, if we are to prevent disease. 

The amount of food to be given at a meal and the frequency of 
the feeding will depend largely upon the size, species and indi- 
vidual. The new-born young need to feed at frequent intervals 
and in small quantities ; but, as they increase in age and the ali- 
mentary tract becomes more and more developed, the amount of 
food may be increased, while the frequency of feeding may be 
constantly decreased until it is reduced to two or three times per 
day. 

During the puerperal state there occur well-marked modifi- 
cations in the function of lactation, varying in the different 
species of animals and in individuals of the same species. The 
cow may milk continuously. If the cow is milked through the 
entire period of gestation and is not dried up prior to parturi- 
tion, there is little if any change noted in the milk except that 
it is increased somewhat in amount just before calving. In all 
domestic animals there is a tendency for lactation to be well 
established when the young is born, especially in the larger 
herbivora, where the young are very active immediately after 
birth. These must, in the wild state, at once possess strength 
and endurance to escape from predatory animals, and this 
necessitates the securing of abundant nutrition in the form of 
milk. Consequently, in the cow, mare and ewe, the milk secre- 
tion has become well established before the birth of the young, 
and the amount is frequently so great that it escapes from the 
udder in streams for days or weeks before parturition. 

From the 3d to the 5th or 6th day after parturition, the colos- 
trum disappears and ordinary milk is present, so that in dairy 
animals the milk is generally considered to be normal in from 3 
to 5 days after parturition and is sold as human food. The milk 
has a density of 1032 to 1041 and is composed essentially of water, 
fat, casein, albumen, milk-sugar and salts. The principal con- 
stituents of milk are somewhat easily separated by various means. 



566 



Veterinary Obstetrics 



The composition of milk varies widely according to species and 
individuality, the methods of feeding, the period of lactation, 
and numerous other conditions. The following table by Vernois 
and Becquerel gives a comparative idea of the composition of the 
milk of various animals, the figures representing the amounts of 
each constituent in looo parts of milk : 



Specific Gravity 

Weight of Water: 

Weight of Solid Parts 

Fat 

Casein and Extractive Matters 

Milk-sugar 

Salts (by incineration) 

Specific Gravity 

Weight of Water ._ 

Weight of Solid Parts 

Fat 

Casein and Extractive Matters 

Milk-sugar 

Salts (by incineration) 



Woman j Cow ■ Goat 



1032.67 
8S9.08 
110.92 
26.661 
39-24' 
43-64 



1033-38 
S64.06 
135-94' 
36.12 
55-15 
38-03 
6.64 



1033-53 
844.90 
155-10 
56.87 
55-14 
36-91 
6.18 



1040. 98 

832.32 

167.68 

51-31 

69.78 

39-43 
7.16 



CAMEt 



134.00 
36.00 
40.00 
58.PO 



1033-74 

904.30 

95,70 

24.36 

33-35 
32.76, 
5.231 



1034-57 

890.12 

109.88 

!8.53 

35-65 

50.46 

5-24 



Sow Bitch 



854.90 
145.10 
19-50 
84.50 
30.30 
10.90 



1041.62 
772.0S 
227.92 

87-95 
116.88 

15-29 
7.80 



Cows which give a large volume of milk may do so at the ex- 
pense of the solid constituents, and especially of the butter fat. 
Thus one cow, which yields a very large amount of milk, may 
show only 2 or 3 % of butter fat, while another, which yields a 
much less amount of milk, may show 6 to 7 % of butter fat. 

Generally speaking, the milk of the smaller domestic animals 
is richer in casein and fat than that of the larger species. The 
milk of the mare, compared with the milk of other animals, is 
very rich in sugar. 

The milk of carnivora is exceedingly rich in casein and fat, so 
that, while it is not abundant, it nevertheless has a very high 
nutritive value, as is well shown by the exceedingly rapid growth 
of their new-born young. On the other hand, the milk of 
carnivora is said to contain almost no sugar, which is in marked- 
contrast to that of other animals. 



Care of the New- Born Animal 567 

Milk contains all the elements necessary for nutrition, consti- 
tutes the natural food for new-born animals and induces in them, 
when supplied in due quantity and of proper quality, very rapid 
growth. 

6. The young animal should be placed and kept under com- 
fortable and favorable conditions, free from extremes of tem- 
perature. Although it may withstand quite high and low 
temperatures without serious injury, if the temperature be 
extremely low the extremities of the new-born, especially the 
ears and tail, verj^ readily freeze, or its life may be quickly im- 
periled under such extreme conditions. In very hot weather flies 
may be exceedingly troublesome and annoying to the young, or 
even very dangerous. For example, they may carry putrid 
infection to the navel of the young animal and cause thereby 
serious and fatal disease, so that we should, as far as possible, 
protect it against these dangers. 

7. Exercise is as essential to the new-born animal as to the 
adult, and possibly even more so. With some species, like the 
carnivora and rabbit, the young are born in so immature a state 
that no marked degree of exercise is possible, but with the 
larger herbivora the young animal is ready for a considerable 
degree of exercise within a few hours after birth, and this should 
be promptly provided in all cases. When the mare is allowed 
the run of a pasture, exercise is fully secured to the foal. In 
case of other animals a similar freedom accomplishes the neces- 
sary ends in the safest and best manner. Otherwise, some provis- 
ions should be made for the daily exercise of the young animal 
as soon as it is capable of taking it. With work animals it is 
not injurious, but rather beneficial, for the foal to follow the 
mother if engaged in slow, light work. 



DYSTOKIA. 

In the preceding pages we have dealt with birth as it occurs 
normally. While it is accompanied by pain and violent efforts 
on the part of the mother, the act is natural and comparatively 
safe for both the mother and the young. There is constant 
danger that birth may become difficult or impossible, without 
artificial aid, and when these difficulties arise we know the con- 
dition as dystokia or difficult labor. 

Normally the obstacles to be overcome in expelling the fetus are 
exceeded by the expelling powers of the female. The obstacles 
to normal birth consist chiefly in the narrowness and undilated con- ■ 
dition of the birth canal as related to the size, form and presenta- 
tion or position of the fetus. When any one of these impediments 
becomes exaggerated in any way, the obstacles to birth become 
accentuated. Constriction of the cervix uteri, displacement of 
the uterus by revolving upon its long axis, narrowness of the 
vulvo-vaginal passage or other impediments may be met, which 
render parturition difficult or impossible except by surgical aid. 
If the fetus should be of abnormal size as related to the dimen- 
sions of the birth canal, if it should be deformed or distorted 
from disease or aberration in development, if its presentation or 
position should be unnatural, or there should be present some 
deviation of an extremity or other part of the body from a 
natural attitude, the impediment to birth may be so great as to 
render artificial aid essential. 

Accordingly dystokia may be divided into two fundamental 
classes. 

1. Maternal dystokia dependent upon some defect, disease 
or displacement of the maternal organs. 

2. Fetal dystokia due to some disease of, or to abnormality in 
the size, form, presentation or position of the fetus. 

The occurrence of dystokia in our domestic animals depends 
very largely upon species, being comparatively common in some 
and comparatively rare in others. The cow readily takes the 
first place in the frequency of dystokia, both of the maternal and 
fetal tj'pes. Dystokia in the mare is not uncommon and takes 
first place in gravity. The bitch, sow and ewe also suffer fre- 
quently from dj'stokia. 
568 



Dystokia 569 

It is difficult to state whether the comparative frequency of 
dystokia is dependent directly upon species or if it is due to the 
prevailing environments or care of the species of animal under 
consideration. The comparative frequency of dystokia in the 
cow and mare varies greatly in different regions of the country, 
according to the character of the breeding industry. Veteri- 
nary obstetrists, as a whole, agree that the cow is far more sub- 
ject to dystokia than the mare. For example, Fleming cites 
two Danish veterinarians, who have had 16 to 19 cases of dys- 
tokia in the cow to one in the mare, even though there were 
more horses than cows reared in their districts. Our own ex- 
perience does not verify this view, and is probably due to the 
difference in the character of our practice as compared with that 
of most writers upon veterinary obstetrics. 

We constantly met in our private practice with more cases of 
dystokia in the mare than in the cow, although in our judgment 
there were annually more cows than mares giving birth to young 
in our territory. It should be explained, however, that the calves 
which were bred in our territory were raised for beef purposes 
and that the pregnant cows were habitually out of doors through- 
out the entire year, were well-fed and strong, were not bred until 
they had attained sufficient size that they would not be likely to 
suffer from dystokia because of immaturity, and were usually 
sent to the butcher before they had attained extreme old age. In 
these animals dystokia was exceedinglj' rare, and it was only in 
exceptional cases that there was any great difficulty in parturition. 

One other element probably served largely to make an apparent 
difference in the frequency of dystokia in the two animals in our 
practice. Owners very generally did not hesitate to attempt 
assistance to the cow and very frequently succeeded fairly well, 
so that our attention was not called to the cases. In mares, 
which, in our territory, were of high value, the owners usually 
desisted from any attempts at bringing about delivery themselves 
and we were more or less promptly called. These considerations 
may have served to make the difference in our experience as 
compared with that of other obstetrists. 

It is constantly to be noted that dystokia runs parallel in fre- 
quency to the confinement of the animal. Consequently we find 
that those females which are most closely housed and least exer- 
cised are the ones which suffer most frequently and seriously 



570 Veterinary Obstetrics 

from dystokia. Hence among all domestic animals the dairy cow, 
which is frequently kept closely confined in a stanchion year in 
and year out, easily takes the first place of importance in refer- 
ence to difficult labor. Cows of the same or similar breeds, when 
not so closely confined nor so intensely used for dairy purposes, are 
not so subject to these accidents, while in beef cows, which are 
habitually permitted to run at large throughout the year, dys- 
tokia is apparently almost, if not quite as rare as in any domestic 
animal. 

The frequency of dystokia as related to environment is greatly 
emphasized by observations upon the bitch and cat. In agri- 
cultural communities, where these animals are habitually out of 
doors daily and lead an active life, dystokia is almost unknown ; 
whereas, in pet females which are kept closely confined in the 
city houses, dystokia is frequent. In Illinois, though we were 
in an extensive swine breeding district, dystokia in the sow 
was almost unknown to us. In New York State, where swine 
breeding is very limited, but the sows are kept closely confined 
in styes, dystokia is comparatively common. 

We are not prepared to state exactly the reasons for these 
differences in the frequency of dystokia as modified by environ- 
ment. Fundamentally, it seems that the proper development of 
the young is largely dependent upon the freedom of the mother 
during gestation, as is shown by the fact that aberration in de- 
velopment, such as double monsters, and other teratologic con- 
ditions, are most frequently observed in those animals which are 
closely confined. The general system, as well as the generative 
organs of the pregnant female, does not preserve its normal vigor 
whenever the animal is closely confined by housing, and so when 
parturition arrives the mother does not possess the needed vigor 
for the expulsion of the 5^oung. 

The influence of the number of young at a given birth upon 
the occurrence of dystokia does not seem to be of very great im- 
portance. In the cow, ewe and goat, twins may simultaneously 
approach the pelvic inlet and, by one or more of the extremities 
of each entering the pelvis, may bring about dystokia, but this 
is not very common. In multiparous animals, the simultaneous 
entrance of two fetuses into the pelvis does not readily occur, and 
dystokia is dependent upon the individual fetus, so that the 
possibility of difficult birth is simply multiplied by the number 



Dystokia 571 

of fetuses in the uterus, any one of which, except the first, 
which is the most dangerous, is almost equally liable to cause 
difficulty in birth. Should dystokia occur from one of the first 
fetuses to be expelled, it inevitably blocks the passage of the fol- 
lowing fetuses, either from both horns, if lodged in the uterine 
body or in the vagina, or from the involved horn in case it be- 
comes arrested in its passage before leaving the cornu. In spite 
of this fact, however, dystokia in these small animals, as we have 
already stated, is very rare, with the- exception of those which 
are closely housed. 

****** 

The importance of dystokia, as related to the possibility or 
probability of delivery, as well as to the recovery of the mother 
and the life of the fetus, varies greatly according to species. 
Among our domestic animals dystokia in the mare easily takes 
first place in its seriousness as affecting the life and well-being 
of the dam and still more in relation to the life of the fetus. The 
great seriousness of dystokia in the mare is largely dependent 
upon the tumultuous character of labor and her susceptibility to 
infection, as well as upon the differences in the conformation of 
the fetus, which renders an adjustment more difficult and injuries 
to the uterus or other parts more liable to occur. 

Parturition is so tumultuous in the mare that serious and fatal 
injuries may occur to her in a very short time, frequently long 
before the obstetrist can arrive, even if called by the owner with- 
out delay. This is in sharp contrast to the cow, in which serious 
injury from labor is not liable to occur until a number of hours 
have passed. 

The exceedingly rapid birth in the mare tends constantly to 
produce ruptures of the uterus, in which the wounds penetrate 
the peritoneal cavity and, as a general rule, end fatally for the 
mother. In the cow these penetrant wounds of the peritoneal 
cavity rarely occur directly from the labor, and even when they 
do they are not nearly so fatal as in the mare. 

The tendency to infection in the mare is very much greater 
than that noted in the cow and constantly assumes a more serious 
aspect for the life of the animal. 

The length of the extremities of the young foal tends con- 
stantly to increase the difficulty of labor in all cases of vicious 
position, because they are far more difficult of adjustment, so 
that embryotomy is more frequently required. Not only are the 



572 Veterinary Obstetrics 

extremities longer, but the}' are comparatively more rigid. In 
addition to all these, the fetus of the mare is usuallj' larger and 
consequently not so readily adjusted as that of the cow. 

Dystokia is not only more serious for the mare than the cow, 
but it is also far more serious for the foal than for the calf. 
During an extensive experience with obstetrics in mares, it has 
not been our fortune to deliver a living foal where there was 
actual dystokia. Our experience is in accord with that of most 
practitioners, and it is only very rarely that the veterinary ob- 
stetrist succeeds in delivering a live foal in cases of dystokia. 
"We have attended mares when living foals were born, but in 
those instances we were hurriedly called by owners of mares 
under the impression that there was something abnormal, which, 
upon our arrival, proved to be normal, and the fetus was very 
quickly born in a natural manner. On the other hand, in the 
cow the common experience is that, if the fetus is alive when 
labor sets in and the veterinarian is called promptly, a living 
calf is secured. This dissimilarity in the two animals has its 
basis largely in the differences in the placentae. The foal quickly 
perishes because of the detachment of the fetal from the maternal 
placenta, whereas the calf continues to live because the placental 
circulation is not interrupted for a long period of time after the 
advent of labor pains. 

From the standpoint of the veterinary obstetrist, dystokia in the 
mare is usually far more formidable than in the cow. The 
tumultuous labor in the mare usually very quickly expels the 
fetal fluids and leaves the passage dry, while it also tends to con- 
stantly accentuate any deviation of fetal parts and otherwise to 
rapidly increase the obtacles to delivery. When the veterinarian 
reaches the case, the violent expulsive efforts of the mare inter- 
fere very seriously with his operations and try his patience and 
endurance to the utmost degree, while the cow is more deliberate 
and the labor pains are much less violent. 

The size of the foal and its very long and rigid limbs and the 
excessively long neck all conspire to render the obstetrist's task 
more difficult and laborious. The tumultuous character of labor 
in the mare calls for greater promptness in bringing about the 
delivery of the fetus, from the standpoint of its own life and that 
of the mare. The mare also is liable to annoy and endanger the 
operator by vicious kicking. 



Dystokia 573 

The cow, on >:he other hand, shows one marked disadvantage 
in manipulation, because she is less amenable to command in 
reference to her position. While the obstetrist usually prefers 
to carry out his examinations and operations with the animal 
in the standing position, the cow is frequently very obstinate 
and will persistently maintain the recumbent position, whereas 
the mare will habitually stand throughout the operation or will 
promptly rise, if able, after she has once gone down. It is 
worthy of note also that inability to rise in the case of the mare is 
very rare, while in the cow it is not uncommon. 

The difficulties of dystokia in all animals bear an almost con- 
stant relation to the promptness of veterinary attendance. If 
the case has been neglected for a long period of time, the fetal 
fluids escape and permit the fetus to become closely invested by 
the uterus and its membranes, so that any changes in the posi- 
tion of the young become much more difficult than when the 
fetal fluids are still present. During the period of delay any 
vicious position of the fetus tends to be constantly accentuated. 
An extremity, which in the beginning was only slightly deviated 
from the normal and could have been corrected in a moment, 
may have become very greatly displaced, and its adjustment 
rendered exceedingly difficult or even impossible, so that it may 
call for embryotomy. 

If the veterinarian is not called promptly, the fetus perishes 
and rigor mortis sets in, which renders any adjustment of its posi- 
tion exceedingly laborious. After the death of the fetus, it un- 
dergoes very rapid decomposition, accompanied by emphysema, 
which increases its size by 50 to 100% or even more, thus greatly 
increasing the difficulties in delivery and the dangers to both the 
animal and the operator from the standpoint of infection. In 
the meantime the mother becomes more and more exhausted and 
less capable of enduring the ordeal through which she must pass. 

A very important element of delay in veterinary attendance 
upon cases of dystokia is the meddling of inexperienced, if not 
ignorant laymen, or still worse, of charlatans, with their crude 
instruments and dirty hands and arms, which have perhaps been 
befouled in attending other cases of a septic character. They 
frequently carry out operations which very greatly increase the 
difficulty for the obstetrist and enormously increase the risk to 
the animal. Perhaps they have already, by some awkwardness, 



574 Veterinary Obstetrics 

placed the life of the mother beyond the possibility of being 
preserved by the veterinarian. 

It is consequently of great importance that the veterinarian 
should use every opportunity to instruct his clients in reference 
to the great importance of calling him early and of leaving the 
case entirely alone until his arrival, except in those instances 
where a little intelligent manipulation may bring about a prompt 
and easy delivery. 

The subject of veterinary obstetrics has not been well studied 
or taught, and the work of many American veterinary obstet- 
rists has been entirely too inefficient to command that con- 
fidence and respect of the stock-owner which it should. If the 
practitioner desires to, be called early he must first be able to 
impress upon his clients, by means of efficient work, the eco- 
nomic advantage of an early call. In order to do this, the vet- 
erinary obstetrist needs prepare himself in an intelligent manner, 
by study, experience and equipment, to render the highest pos- 
sible service in promptness and efficiency. 

Some writers upon obstetrics would well-nigh exclude many 
veterinarians from obstetric practice because of their physique. 
But some of the conditions which they regard as essential to 
success are not really of such great importance as they would 
have us believe. Any man of moderate size, strength and power 
of endurance can succeed as an obstetrist, if he will but give his 
subject that amount of study and research which its importance 
demands. Some say that long and powerful arms are absolutely 
neces.sary, and we will admit that they possess certain advan- 
tages. But a " long head " is worth more than an extra one or 
two inches in length of arm. 

As in other surgical operations, the veterinary obstetrist re- 
quires, above all, intelligence, education, experience, and de- 
termination. 

He must husband his strength, must possess the ability to 
have others carry out any manipulations or work which they 
can properly do under his directions, and must reserve his own 
force and strength for the proper direction of the work of others 
and for those manipulations which he alone is competent to 
properly perform. It is not his office to exert traction upon a 
fetus when a bystander can do it equally well. Such labor is 



Dystokia 575 

directly opposed to the interests of the animal, the owner. and 
himself. 

The veterinarian is called upon to carry out no work in his 
profession which is more exacting than the overcoming of dys- 
tokia in our larger domestic animals. It calls for the highest 
possible training and the most ready mental resources at every 
turn. No two cases are alike, and each demands effective judg- 
ment rather than conformity to a fixed rule of procedure. The 
veterinarian must be ready to judiciously meet each obstacle as 
it presents itself, must meet it promptly, sometimes in a moment, 
and yet throughout the entire procedure, from the beginning of 
the examination to the extraction of the fetus, must preserve his 
patience and equanimity, and in order to do this must conserve 
his physical powers as far as is possible. 



EQUIPMENT FOR OBSTETRIC WORK. 

In order to succeed in obstetric work, the veterinarian must 
be judiciously equipped for it, not only from the standpoint of 
quantitj' and qualitj', but also in reference to the readiness of his 
equipment for immediate use. The obstetric equipment of the 
veterinarian should be carefully selected and arranged, should 
include every article which is likely to be needed during any 
obstetric operation, and should be carefullj' packed in one or more 
containers readj' for immediate transportation, so that no article 
of importance will be left behind or forgotten. 

The instruments of the veterinary obstetrist should be ample 
in number, simple in character, and efficient for any operation 
or manipulation which he ma}' possibly be called upon to per- 
form. Obstetric instruments are of the greatest possible design 
and variety, and it is not practicable for us to enter into detail in 
relation to the multitudinous varieties which have been proposed 
by various operators and writers. 

Obstetrical instruments are intended to aid in, or to accomplish 
three distinct offices : traction, repulsion and incision or excision. 

For the production of traction, the appliances most frequently 
used are cords, bands, halters, hooks, forceps and nooses. 

Cords and bands are of every possible description and variety 
and may be either very simple or quite complex. Usually speak- 
ing the simplest are the best for two important reasons. One 
maj' accomplish with simplj' a looped cord any operation which 
is possible with the most complex. When one operation with a 
cord, band or halter has been carried out, the apparatus is of 
no further value for obstetric uses, but becomes a danger in suc- 
ceeding cases, which is to be constantly avoided b}' the destruc- 
tion of the apparatus after a single use, and this means an im- 
portant expense in case of complex appliances. 

We prefer the simple, cotton cord, Fig. 91a, about 3-^ inch in 
diameter and 4 feet in length, one end to be wound with strong 
thread to prevent ravelling, while at the other a spliced loop is 
formed of sufficient size to permit the cord to play through it 
freely. It is not advantageous to have all these of uniform size 
because, in some instances where the traction is not to be 
severe, a smaller cord than s/a in. may be more easily applied 
and retain its hold more securely upon a part. In some cases it 



Cords, Bands aiid Halters 577 

is advantageous to use various sized cords because they may 
thus be more readily distinguishable from each other. When 
severe traction is required, a yi in. rope may be found necessary. 

The ropes should be prepared carefully and should preferabl}^ 
be sterilized or disinfected in advance and carefully wrapped in 
impervious paper in such a way that they will not become con- 
taminated before ready for use. They should be made in suffi- 
cient numbers, according to the volume of the practitioner's 
obstetric work, and should be ready when wanted. 

Other veterinarians use and advise bands of various kinds, 
such as are shown in Fig. 91, c, and d, instead of cords. 
These are more difficult to obtain, are expensive, and have no 
advantage in efficiency. They may wound or abrade the genital 
passage of the mother somewhat less, but the difference is not 
important, and the cotton cord which is twisted only moderately 
hard meets the requirements quite fully in reference to this dan- 
ger. Some writers claim that a cord with a running noose may 
injure the part of the fetus to which it has been attached, but 
this we have never observed. Others prefer a leather band, but, 
while this is efficient in many respects, it does not keep its hold 
upon a part as well as a cord and it is highly expensive and 
cannot be readily sterilized. 

Halters, h. Fig. 91, are recommended by many obstetrists, 
where the traction is to be applied to the head, but these are ex- 
ceedingly difficult of adjustment and are but little, if any, supe- 
rior in efficiency to the simple cord or to the hook. They are 
expensive, and the difficulty of rendering them sterile constitutes 
a formidable objection to their repeated use. Numerous head 
collars or halters are described by various veterinary obstetrists, 
such as those of Binz, Rueff, and others, while for the smaller 
animals Binz recommends what is termed a forceps-band. 

When the halter has been applied to the head of the fetus it 
possesses an advantage over the simple noose around the neck 
because, if the halter stale pulls upon the chin of the fetus, it 
tends to keep the head in a direct line, which favors its passage 
through the canal. Even with the halter adjusted in the best 
possible way, the simple cord can be so applied that it fully 
answers the same purpose. If we take a long cord and apply it 
as a noose about the neck of the fetus with the loop in the region 
of the larynx, we can then place a half-hitch around the nose in 
37 



578 



Veterinary Obstetrics 



such a way that we can draw directly upon the median line of 
the ventral surface of the head with the same accuracy and 
efficiency as with the best adjusted halter. The application of 
the cord in this waj' is simpler and easier than the halter. The 
objection may be raised that the running noose about the neck 




Fig. 91. Cords and Traction Appliances. 

a, Ordinary noose with spliced loop, f, Breulet's obstetric noose for dogs. 

b, Ring noose. g, g, Defay's obstetric noose for dogs, 

c, Braided obstetric noose. closed and open respectively. 

d, Loweg's obstetric strap. h, RuefT's obstetric halter. 

e, Darreau's long noose carrier. i, Obstetric noose of annealed copper 

wire. ( Hauptner. ) 

may strangle or otherwise injure the fetus. This is sentimental 
rather than scientific, because while traction is being exerted up- 
on the head of the fetus it is not breathing, and consequently 
there is no interference with respiration, and evidently no other 
serious harm is probable. Evidently traction should not be 
exerted by means of a running noose upon the neck of a live fetus 



Cords, Bands and Halters 579 

after its chest has emerged from the vulva and the establishment 
of respiration has become necessary. Neither is traction by the 
neck demanded at such stages, since this ma}' be preferably 
applied to the fore-legs. 

Cords are applied to the limbs and head by two distinct plans. 
The running noose of the cord, already formed, is introduced into 
the genital passages and slipped over the foot of the fetus up to 
the pastern, above the fetlock, or even higher, according to con- 
ditions. The distal end of the cord is then drawn taut by the 
operator or an assistant, and thus made fast upon the part in a 
manner which permits any degree of traction desired. 

A second method of applying the cord to the limb is used in 
those cases where the foot is not available to slip the ready-formed 
noose over it, and it must instead be passed around the limb to be 
later made fast. For this purpose the looped end of the cord 
may be carried in the hollow of the hand to the limb which it is 
desired to secure, the end carried around the limb as far as pos- 
sible, and then grasped from the opposite .side of the limb and 
drawn out through the vulva. By passing the distal end of the 
cord through the loop and drawing upon it with one hand while 
pressing upon the loop with the other, the noose is guided back 
to that part of the limb to which it is desirable or possible to 
secure it, and drawn tight. 

In order to accomplish this operation, the fetal membranes must 
be removed from the limb at the point to be secured with the 
cord. This sometimes offers considerable difficulty. When the 
cord is passed partly around the limb and dropped, before the 
membranes have been well ruptured, and the hand passed around 
to the other side to grasp the cord, the end of the cord is, by the 
elasticity of the membranes, thrown away from the position in 
which it was deposited, and consequently cannot be secured from 
the other side. Even when the membranes are fairly well ruptured, 
there is sometimes difficulty because of the cord following the 
hand backward as it is withdrawn, and thus becoming displaced. 
We find it a great advantage, in overcoming this difficulty, to 
fold the looped end of the rope in a comparatively large mass, 
which is carried in the hollow of the hand. When this folded cord 
is delivered as far around the limb as is practicable , we find that 
while the hand is being withdrawn the rope may partly uncoil and 
follow it, but most of the rope, including the loop, will remain in 



580 Veterinary Obstetrics 

position and may be grasped from the other side and drawn out. 

Some practitioners use what is known as a porte-cord or cord- 
carrier, Fig. 106 f , in order to aid in securing the limb under the 
conditions we have just named. Such an instrument may be 
made to serve the double purpose of a cord- carrier and a blunt 
hook. There are numerous patterns of these, but they do not 
seem to possess a verj' high value in actual practice and are not 
largely'used. In some cases, where there is great difficulty in 
passing a cord around a limb because of the presence of fetal 
membranes, the instrument may be of great advantage. With it 
the operator can hold the cord in place by means of the instru- 
ment, while the|;hand is passed around the other side of the limb 
and the cord grasped. Once the cord is grasped the instrument 
is usually withdrawn, while the operator holds the looped end of 
the cord and guards the end of the instrument to prevent its 
catching'in^any of the soft parts. When the porte-cord has been 
withdrawn, the fastening of the cord about the limb is carried 
out in the same waj' as without the use of the instrument. Per- 
sonally we have found little use for the porte-cord and have not 
seen a case where we might have applied a cord with the aid of 
this instrument in which we could not also accomplish this with- 
out it. In some instances the application of the cord is easier 
with the instrument. 

When cords are to be applied to the neck, and the head is in a 
direct line, the nose presenting, the cord may be applied to the 
neck, as an open noose, by slipping it back over the nose and later 
the ears, until it rests upon the poll above and in the pharyngeal 
region below. Then drawing upon the cord we may exert what- 
ever traction is desired. With a simple loop about the neck 
there will be a constant tendency for the head to deviate from a 
direct line, which may be overcome by taking a half hitch around 
the nose or around the lower jaw, so that any traction which may 
be exerted will keep the nose and head in a direct line with the 
genital canal. 

When the head and neck are ,so deviated that it is impossible 
to slip the completed noose over the head, and back upon the 
neck, the looped end of the cord may be carried as far as possible 
over one side of the neck, deposited at that point and then, 
by reaching around the neck from the other direction, grasped from 
the opposite side. When the looped end has been secured, it 



Cords, Bands and Halters 581 

should be drawn out through the vulva, the free end of the cord 
passed through the loop and, by drawing upon it, the neck 
secured in the running noose. In order to aid in passing the cord 
around the neck in this way, various devices have been proposed 
in the form of curved sounds or curved porte-cords, but they 
have apparently acquired no permanent place in obstetric prac- 
tice. In some instances the}' may prove quite useful, especiallj^ 
if the head cannot be reached in such a way as to cord the lower 
jaw or to engage the head with a hook in the orbit. In those 
cases of extreme deviation, however, where the head is out of 
reach, it is often desirable to not try to secure the head, but 
rather to perform embryotomy and to decrease the size of the 
fetus to such an extent that the deviation of the head may be 
easily corrected or the fetus may be extracted without correcting 
the deviation. 

One of the most useful places for the attachment of cords is 
the inferior maxilla of the fetus. In the various deviations of 
the head there are few methods which are more advantageous to 
the practitioner than traction upon the lower jaw. When prop- 
erlj' applied, it affords a very secure attachment, which permits 
an almost unlimited amount of traction and in a very advanta- 
geous direction. Some obstetrists have said that they could not 
securelj' appl}' a cord to the lower jaw of the fetus, and especially 
to that of the foal, because it very readily slips off and so does 
not offer a secure hold. Our experience has been wholly differ- 
ent, and we have constantly found that a cord can be very 
securely fastened to this part, as shown in Fig. 108. We pro- 
ceed as follows : First, with the ring-knife or other cutting in- 
strument we make an incision 3 or 4 cm. long, between the rami 
of the lower jaw, through the skin and superposed tissues, into 
the oral cavitj^. Next, we pass the prepared noose of the cord over 
the jaw and push it back beyond the incision with the loop rest- 
ing in the mouth of the fetus. We then pass the free end of the 
cord through the incision .from the oral cavity outward, and draw 
firmly upon the cord so as to tighten it, after which any amount 
of traction desired may be employed without any danger of 
slipping or of tearing out. By this method the two rami of the 
jaw are held together, instead of being split apart as when a hook 
is used. The objection may be raised that, in case of a living 
fetus, mutilation is caused, but the wound is so insignificant in 



582 Veterinary Obstetrics 

character that there is no reason why it should not heal very 
promptly and without blemish. 

A few practitioners also pass cords around the loins of the fetus, 
in case of posterior presentation, with the hind limbs completely 
retained, but, so far as we know, this plan of procedure has not 
been generally adopted. Personally, we see no need for this very 
tedious plan, which, if completed, still offers very great danger 
for the mother and virtually no hope for the life of the fetus. 
In our experience there are other plans of procedure which are 
simpler and more effective. 

In addition to cords and bands there are other methods for ap- 
plying traction, among which may be mentioned the annealed 
wire-loop. Fig. 91 i, for the larger animals. Similar devices for 
small animals may consist of a small tube of metal or other suit- 
able material, through which is passed a wire loop, as shown in 
Fig. 91 f, or a more complex device such as that of Defay, g. g.. 
Fig. 91. 

Hooks. Few obstetric instruments have been so much used and 
made of so many patterns as hooks. They may be divided into 
long and short. Those which, when attached to a por- 
tion of the fetus within the birth canal, will be completely 
hidden, are called short hooks, j and k. Fig, 92 and b. Fig. 106. 
Those which are of such a length that, when applied to a given 
part of the fetus, their distal ends project beyond the vulva like 
a to e. Fig. 92, and g. Fig. 106, we denominate long hooks. Hooks ' 
may be either sharp or blunt. 

Some hooks are used singly and others doubly or in pairs. In 
case of the short hooks, especially the finger hook, the traction 
must be applied through the medium of a cord passsed through an 
eye in the hook or through the medium of the operator's hand. 
The long hooks are applied to the desired point accompanied by 
the hand of the operator, and traction is exerted from the outside 
through the aid of an assistant. 

The advantages and disadvantages of long and short hooks are 
largely matters of personal experience. One practitioner becomes 
accustomed to the short hook, another to the long, and each be- 
lieves that his kind is the better. As a matter of fact there are 
few things which can be accomplished with one of these hooks 
which cannot be done with almost the same facility with the 
other. There are few, if any, places that a short hook can be 



Obstetric Hooks 



583 



applied where a long hook could not also be inserted with equal 
facility, or vice versa. 

There is one difference which is of importance. With the long 
hook the operator may, by pushing upon the instrument from 
the outside, aid the hand in reaching a trifle further and implant- 
ing the hook in a part not practicable with the short instrument. 
Also, the point of the long hook may be turned in any direction 




n 




6 



Fig. 92. Obstetric Hooks. 



a, Long embryotomy hook (39 in) 

b, Jointed obstetric hook . 

c, Rectal liook of Harms. 

d, Single hook for small animals. 

e, Double hook for small animals. 

f, Harms' eye hooks. 



g, Riemer's double obstetric hooks, 
h, Brogniez' obstetric hooks, 
i, Harms' flank hooks, 
j. Sharp hinged hook of Scharnier. 
k, Blunt hinged hook of Scharnier. 
(Hauptner). 



through the agency of the outside hand, when such control might 
not be possible with the short hook dependent for guidance 
wholly upon the inserted hand. 

In comparing the sharp and blunt hooks, most practitioners 
favor the latter for most excellent reasons. It is exceedingly 
difficult to apply a sharp hook with safety for either the mother 



584 Veteritiary Obstetrics 

or the operator. It is an ugl}' instrument to handle unless we 
first place our patient under complete anaesthesia, because, while 
carrying a sharp hook in the hand for insertion at a given point, 
we are almost certain to have our progress interrupted by violent 
expulsive efforts on the part of our patient, and it is only by the 
ver3' greatest caution and dexterity that we avoid at such times 
serious wounds to our hands or to the genital organs of the 
mother. After repeated trials with the sharp hooks, without 
having been benefitted by them in a single case, we finally aban- 
doned all attempts to use them. Even .should we desire to fix a 
hook in a part where the blunt point would not enter on account 
of the skin, we may, as a rule, incise the integument and thus 
prepare an opening for the blunt instrument. 

The form of the hook is highly important. They are made in 
every conceivable form, and many makers apparently ignore all 
mechanical principles and construct an instrument which does 
not serve the purpose with that security and safety desired. 
Aside from the question of strength and finish, it is essential that 
a hook be so constructed that, when once inserted into the 
tissues and traction is exerted upon it, its form shall cause it 
to sink deeper and deeper into the parts and acquire a hold with 
constantly increa.sing security. The hook .should leave the shaft 
at an angle of about 45° and need continue in a straight line, or 
nearly so, to the end. The right and wrong forms of hooks are 
illustrated by Figs. 92 a, d, and 106 g. A study of these instru- 
ments will show that 92 a would have scarcely any tendency 
to sink deeper and deeper into the tissue, while Fig. io5 g would 
constantly press deeper into the parts to which it is applied. 
The width of the opening of the hook should not exceed 2.5 to 
3 in. so that the operator may readilj^ conceal it in his hand dur- 
ing insertion or withdrawal. 

Double hooks have been proposed by man3' obstetrists, and some 
of them have been used extensively. Harms especially rec- 
ommends his flank hooks. Fig. 92 i, which are about 17 cm. 
long and are intended to be inserted one in each flank, when the 
fetus presents by its croup and it is wished to bring about forci- 
ble extraction. We constantly prefer embryotomy to forcible 
extraction, which Harms and others recommend, and conse- 
quently find no need for these appliances. Others use hooks of 
a somewhat similar character for correction of the deviation of 
the head by applying one hook in each orbit. 



Obstetric Hooks 



585 



When a hook is used for the development of traction, when- 
ever force is applied, the instrument must be constantly guarded 
by the operator's hand lest it slip or tear out and lacerate the 
uterus. This applies with special force to the sharp hook. 

In the application of hooks, the operator should always aim to 
select a point where the instrument will be secure against tear- 
ing out, and in order to do this he needs have well in mind the 
anatomical structure of the fetus and the resistance of various 
parts. 




Fig. 93. Obstetric Forceps, 

a, Roeder's obstetric forceps for 

swine. 

b, Pig forceps. Walch's. 

c, Obstetric forceps for swine and 

goats. Witt's. 



d, Moeller's bitch forceps. 

e, Ellinger's pig forceps. 

f, deBruin's forceps for sheep. 

g, deBruin's bitch forceps. 
( Hauptner ) . 



Anteriorlj' the hooks may be inserted with comparative safety 
in the orbits. The point of the hook should be sunk deeply into 
the orbit and should force its way through the bony walls of that 
cavity into the sinuses of the face. For this purpose the hook 
should be about 3 inches in length. In correcting a slight devi- 
ation of the head, it may be allowable at times to insert the hook 
into the lower jaw between its two branches, but this constitutes 
a very insecure hold, which will give way under very moderate 
traction and consequently does not permit of great force. When 
it is wished to apply severe traction to the lower jaw, the cord 
should be used as already described. 



586 Veterinary Obstetrics 

When the fetus presents posteriorly, the points which offer the 
most secure insertion for hooks are the borders of the bones of the 
pelvis. The hooks may be implanted in front of the pubic brim 
or of the ilium, or in the oval foramen, either from without or 
within. It is much safer to insert the hook in the pelvis from 
without, inwards. If inserted from within, the point of the 
hook must be constantly guarded, lest it push through the soft 
tissues of the fetus and lacerate the genital canal of the mother. 

Obstetric forceps of great variety have been proposed by 
various writers, but they have not come into general use and ap- 
parently cannot serve any important purpose in the larger ani- 
mals. The immense forceps of Jorg are too voluminous and 
heavy to be applied to the head of the fetus in the genital canal 
and, were they once applied, no power of an}^ efficiency could be 
exerted thereon. Various types of these forceps have been in- 
vented, but each alike has failed to serve any purpose. 

In smaller animals obstetric forceps have proven highly useful 
and practical. They constitute one of the safest and most efl&- 
cient methods for applying traction to the fetus of the cat, bitch, 
sow and, to a lesser degree, the ewe and goat. Some of the most 
useful of these are illustrated in Fig. 93. 

Among the various means for the application of traction, the 
safest is the cord. It constitutes the only appliance which the 
operator can leave unguarded. 

The application of traction to the fetus in cases of dys- 
tokia will vary largely in the intensity allowable, the direction in 
which it is best to exert it and the means which may most use- 
fully be employed in developing the necessary force. 

The direction in which traction is to be applied will de- 
pend very largely upon the attitude of the fetus and the point 
which it has reached in the birth channel. As we have already 
suggested in a preceding chapter, the fetus of our domestic ani- 
mals, and especially of the larger ones, normally assumes a some- 
what curved position. The ventral surface of the fetus is con- 
cave and the dorsal is convex, which curvature may be increased 
very greatly hy artificial means, but the normal curve in the fetal 
body does not readily undergo obliteration or reversal by the fetal 
body being bent dorsalwards. 

As the fetus approaches the pelvic inlet, in our larger domestic 
animals, and especially in those cases where the animal is stand- 



Application of Traction 587 

ing, it is located below the pubic brim and must mount that 
obstacle in order to gain the pelvic canal. Presenting thus, 
if traction should be necessary or desired, it should be applied to 
the fetus somewhat obliquely upward, so as to lift the fetus up- 
ward and backward over the pubic brim. 

During the progress of the fetal head through the pelvis, the 
traction should be directly backward or slightlj^ upward and 
backward, but, when the fetal head arrives at the vulva, if the 
traction is continued upward it tends to force the poll of the head 
too powerfully against the superior vulvar commissure, and not 
only tends thereby to cause an obstruction to delivery by jam- 
ming the fetal head against this part, but also endangers the in- 
tegrity of the superior commissure of the vulva itself and tends 
to cause more or less laceration of it. Consequently the direc- 
tion at this point should be somewhat downward in order to 
avoid, as far as possible, any injury to the soft parts. 

After the head has passed through the vulva, the traction 
should be continued more and more downward as the body of the 
fetus advances, until finally, when the withers have passed the 
vulva, the line of traction should be almost perpendicular to the 
long axis of the .spinal column of the mother or parallel to the 
long axis of the posterior limbs of the mother. 

If the animal is standing, the direction of traction, when the 
fetus is well advanced, should be immediately downward toward 
the floor, or if she is b'ing down it should be directed toward 
her hind feet. Such a direction in traction permits the ventral 
wall of the fetal body to become somewhat relaxed, and in this way 
the fetal viscera may pass backward or forward in the body cav- 
ity and thus escape from that part of the cavity which is being 
most compressed in the birth passage, thereby decreasing the 
diameter of the fetal body at the most critical point. 

The downward direction of the traction pulls the tuberosities 
of the fetal ilia downward from the uppermost part of the 
maternal pelvis, and prevents their becoming interlocked with 
those of the mother. 

Unless care is exercised at this time, the fetal and maternal 
pelves become immovably locked. We have repeatedly seen this 
occur where one or two horses have been hitched to the head of 
a calf and violent traction employed in a direct line without 



588 Veteri7iary Obstetrics 

moving the fetus, although the presentation, position, fetus and 
maternal pelvis were each apparently normal. 

The amount of traction. In passing through the birth 
canal the fetus and the maternal parts in contact with the fetus 
undergo an enormous pressure because of the comparative nar- 
rowness of the canal. This pressure is to a great extent inevit- 
able, and it is only when it becomes excessively high that it 
has any danger for the fetus or mother. 

In veterinary practice we .scarcely recognize the presence of 
any danger whatever to the fetus from the pressure during its 
passage through the birth canal, nor as a rule do we observe any 
injury to the fetus because of traction applied to any of its ex- 
tremeties. The amount of traction which will be boine by the 
head or the limbs of a fetus during its passage through the canal 
is astonishing. It far surpasses any point which an average per- 
son would believe possible for the fetus to endure without more 
or less serious injur}\ and yet, as a rule, strain or other in- 
jurj' to the fetus from such traction is virtually unknown in 
practice. 

The mother, however, not infrequently suffers seriously from 
severe, or rather we might say, from injudicious traction. , How 
much pressure the pelvis of our domestic animals will withstand, 
when applied through the medium of a fetus impacted within its 
canal, we do not know. Experimentally, it has required from 
375 to 635 pounds pressure upon a round ball representing the 
head of the fetus, to produce a fracture of the bones or disunion 
of the pelvis of woman. 

The great danger to the organs of the domestic animal is not 
to the bony, but to the soft parts, and it is these which are first 
injured by an excessive pressure. 

The amount of traction which may be applied to the fetus 
varies with its position. When the fetus is presenting normally 
and the traction is exerted in the direction which we have sug- 
gested, there is no point where the soft tissues of the fetus may 
not move to some extent upon each other and thus relieve the 
pressure upon a given point, so that in normal cases the pressure 
of the fetus against the walls of the birth canal is well nigh equal 
over the entire surface. 

When the fetus presents improperly, when an extremity is re- 
tained in such a way that a greatly increased pressure is brought 



Application of Traction 589 

to bear upon one small area of the genital passages of the mother, 
the question of the amount of admissible traction changes greatly. 
For example, if a fetus is presenting with its head deviated to 
the side, one man by drawing upon it may cause far more injury 
than five men might do if the fetus were presenting normally. 

Different practitioners, working under varying conditions, have 
obtained apparently contradictory results in reference to the 
amount of traction which it is desirable to employ. Some claim 
that only moderate traction should be employed, and define their 
term ' ' moderate ' ' as the force of from 2 to 4 men pulling simul- 
taneously. Others have unhesitatingly employed the combined 
strength of from 6 to 10 men and have claimed that their success 
has fully warranted the amount of force employed. Personally 
we have, when hard pressed, applied a force which would equal 
that of 6 to 10 ordinary men, in those cases in the cow and mare 
where the fetus lay in a wholly natural position, and when the 
force of the traction fell alike over the entire birth canal. 
Usually, when it reaches the point where so great force has be- 
come necessary, we have not used this number of men, but have 
substituted some mechanical appliance for their power, such as 
the lever or pulley. 

Donnareix claims that three assistants are usually sufficient 
for handling dystokia in the cow. Of these, he places one at the 
head, another at the tail and a third to aid the operator. In 
contrast with this he finds 10 men necessary for the mare and 
distributes them somewhat similarly, except that an extra man 
is needed to confine the limbs of the animal, while 5 or 6 are 
needed to pull at the fetus. While the amount of assistance 
required in a given case constantly varies in either the mare or 
the cow, we have never found the great number either neccessary 
or desirable, and have always considered that we could better 
manage from 3 to 5 men than a larger number and that we could 
always develop mechanical force of sufficient degree to get the 
power desired. 

When traction is applied to a fetus which is not in a proper 
position and in which the fetal pressure is not alike upon the en- 
tire area of the maternal passages, great and even fatal injuries 
to the mother are constantly threatened. If a limb is retained 
or misdirected it is liable at any time to be forced through the 
uterine wall into the peritoneal cavity and produce a rupture. 



590 Vetermary Obstetrics 

from which the animal usually dies as a result of shock, hemor- 
rhage, or infection. 

In other cases, when a portion of the fetus is deviated, the 
walls of the uterus, which are closely investing the fetal body, 
may be caught during severe traction and dragged along until a 
small rupture is caused, or the uterine walls so seriously crushed 
and maimed that they later become necrotic and a secondary per- 
foration of the uterus occurs. When the fetus is further ad- 
vanced in the pelvic canal and approaches the outlet, any great 
deviation o the presenting parts of the fetus may cause a very, 
serious rupture of the perineum. Therefore, the application 
of great force to a fetus in an improper position is con- 
stantly to be condemned. 

In the selection of assistants, when there is a sufficient num- 
ber present to permit of selection, one should take 'hx preference 
those persons who are somewhat experienced in the handling of 
animals and who are strong and of equable temperament. One 
needs to have these men thoroughly at his command and to know 
that they will obey his orders prompth- and without question. It 
has been a common experience of the writer, when he has asked 
that two or three men shall take hold of a rope to exert traction, 
that upon turning his head he finds that the number has doubled 
or trebled. This must be constanth' watched in case of a crowd 
of bystanders. 

When traction is being applied the operator should take his 
place immediateh" behind the patient, constantly watch and 
examine the progress of the fetus, command the direction and 
amount of force to be applied at this or that time, and determine 
when the traction should cease. Various conditions maj- arise de- 
manding that the traction shall be more to the right or the left, 
upward or downward, or otherwi.se modified. 

\\^hen there seems to be any great impediment which appar- 
ently bars the progress of the fetus at a given point, the traction 
should cease and the operator should determine the nature of the 
obstacle to its progress and devise the necessarj' means for over- 
coming" it. The operator should not join in the traction unless 
circumstances should arise making it necessar}', but should de- 
vote his attention to the direction of the force to be applied by 
others. 



Application of Traction 591 

Haste in traction upon a fetus is only very rarely justifiable, 
and the maternal parts should be allowed to dilate gradually as 
the fetus slowly advances in the form of a wedge. In posterior 
presentation, when a supposedly live fetus is well advanced in 
the pelvis so that the umbilic cord is impinged between the fetal 
body and the maternal pelvis, hasty extraction of the fetus may 
be warranted in order to save its life. Very rarely, possibl}', other 
■conditions arise to warrant hasty extraction of the fetus. 

Traction should, if possible, only be applied during the expul- 
sive efforts of the mother, since at these times it is very much 
safer, and more efficient. Traction applied in the absence of ex- 
pulsive efforts constantly tends to drag the uterus along with the 
fetus, with danger of uterine rupture. 

Expulsive efforts of the mother may usually be artificially 
aroused by slight traction upon the fetus or by the operator 
passing his hand between the fetus and the vaginal walls. When 
these efforts have been aroused they should promptly be seconded 
by firm traction, to be regulated in amount according to the cir- 
cumstances in each case. Before traction is applied, and as far 
as possible during its continuance, the birth canal should be kept 
moist and well lubricated by means of oil, fat, or warm lysol so- 
lution. 

While traction should be applied, as a rule, only during expul- 
sive efforts, in some cases, when the animal is exhausted or under 
the influence of an anaesthetic, the expulsive powers may be 
partly or wholly wanting and forcible extraction made necessary. 

The general rules for the application of traction — the direction, 
amount and method — are essentially the same whether ^. the fetus 
presents anteriorly or posteriorly. 

The development of the required amount of force, when 
applying traction to the fetus, may be brought about in a variety 
of ways. 

We have already suggested that the difficulties increase as the 
number of men increases, because a large number of men is diffi- 
cult to control. They are almost always excited and tend to exert 
their force in an irrational manner. Since they necessarily work 
behind the operator's back, he has little opportunity to watch 
them, while giving proper attention to the progress of the fetus. 
In some cases the men who are at the command of the operator 



592 Veterinary Obstetrics 

are not very intelligent, and such persons at once render his task 
more difficult in controlling the application of force. 

The barbarous method, which is more or less in vogue, of de- 
veloping force by hitching one or more horses to the foal or calf, 
requires no condemnation. Such a force is quite beyond control. 
The horses become excited and jump or jerk in such a way as 
to be exceedingly dangerous for the mother and fetus, if the latter 
is yet alive. After one or two ineffectual efforts to overcome 
the resistance, the horse behaves so badly that his starting ' and 
stopping cannot be depended upon. Besides this we have very 
poor control, under these circumstances, of the direction in which 
the force is to be exerted. Any sudden movement of the patient 
changes the direction of the traction quite as suddenly and may 
be fraught with serious results. 

When power must be developed, requiring the force of more 
than 4 or 5 men, it is preferable according to our experience to 
supplant the men with mechanical appliances, of which we have 
many. The two to which we have usually re-sorted, and which 
have given us highly satisfactory results, have been the lever and 
the puUe}-. 

The lever is universally available and can be applied under 
almost any conditions which might be named, except possibly in 
those instances where the stall in which the operation is under- 
taken is too small to permit of its use. In such instances, 
however, it is almost equally difficult to apply other mechanical 
force. Our method has been to procure a stout beam from 8 to lo 
feet in length and to find a secure resting place for the fixed end 
of the lever, which is to act as a fulcrum, against a door, post, or 
other solid object. If the animal is in the pasture, or otherwise in 
the open, and recumbent, a stout stake may be driven in the 
ground to serve as a fulcrum and the end of the lever placed 
against this. A hole may be made in the ground or in the floor 
and the end of the lever inserted into this. The cord or rope 
which is attached to the fetus may then be made fast to the 
lever at a distance of about two feet from the fulcrum and the 
power applied to the long arm of the lever, by one, two or more 
men, as conditions may warrant. The amount of power which 
may be developed in this way is virtually unlimited, its direc- 
tion is under excellent control, and it is free from irregularities 
in its application. 



Application of Tradioji 593 

Much the same may be said of the pulley, by which we can 
increase the force at will and can quite readily control the di- 
rection of the traction at every stage of progress. The pulley 
has the one very marked advantage that it may be carried in a 
very compact form by the operator, as a part of his equipment, 
and be ready for application whenever occasion arises. 

Others have used, for the purpose of developing mechanical 
force, various apparatuses in case of emergency, such as the wind- 
lass, capstan, and various obstetric machines, which have been 
worked by means of a screw or otherwise. However, the two 
which we have suggested are so universally available and so effi- 
cient that it would seem scarcely necessary to discuss the others 
beyond admitting that, when they chance to be at hand, they 
may act quite as well as those which we have habitually used. 

While these mechanical devices for the development of force 
seem in some respects cruel, they are not so at all when com- 
pared with other means for which they are substituted. Veter- 
inarians in general condemn the practice of hitching horses or 
oxen to a fetus in order to draw it away, as being cruel and un- 
justified by any principles of surgery or of humanity. Unless a 
number of men can be well controlled in their efforts, it is no 
more humane, nor is it any more scientific, to place 8 or 10 men 
upon a cord to draw upon a fetus than it is to hitch a horse to it. 

Mechanical means for the application of force are far more 
under the control of the operator, are more continuous and better 
directed. In our judgment, where a certain force is necessary, 
which cannot be accomplished by three or four men, the mechan- 
ical appliance is safer and more effective. In our comparison we 
are dealing with the question of the application of a given amount 
of force with like supervision. Admittedly, with mechanical 
means we can apply such an unlimited force as to tear either the 
fetus or mother asunder, but so we may by manual force if we 
but sufficiently multiply the number of men. 

The amount of force to be applied in a given case constitutes a 
severe test of the judgment of the veterinarian. It is a practi- 
cal question which should be decided upon sound principles. In 
almost any case of dystokia we may reduce the size of the fetus, 
by embryotomy, to such dimension that but little force will be 
required to bring about its extraction from the uterus. If this 
can be readily accomplished, and the fetus is dead, it follows that 
38 



594 Veterinary Obstetrics 

such is the proper action to take. We are not justified, for ex- 
ample, in applj'ing great traction to a fetus presenting posteriorly 
with the two hind feet completely retained, when by intra-fetal 
embrytomy, with removal of the two hind limbs, we may so re- 
duce the size of the fetus, in the course of an hour, as to permit 
of its easjr extraction by the traction of say two persons. 

On the other hand, we recall an instance in our personal expe- 
rience where a foal was in the breech presentation with both hind 
limbs completely retained, and, as it had been dead for some 
time, the waters had all escaped. The fetus was enormously 
enlarged because of emphysema as a result of decomposition. 
We removed the two hind limbs, the pelvis and all the fetal 
viscera, and then attached a cord to the posterior end of the 
spinal column and applied traction. The fetus was in the dorso- 
sacral position and there was no impediment to its extraction 
except the great emphysema. 

We might have further reduced the size of the fetal body 
bj' removing the ribs and then withdrawing one of the shoulders, 
and with it the fore-leg. We might have repeated the process 
upon the other fore-leg, and perhaps this would have been 
the more surgical and approved method, but, before we realized 
the seriousness of the obstacle to extraction, we had wedged 
the fetus quite tightly in the birth canal so that further opera- 
tion was rendered exceedingly difficult. Rather than go through 
the tedious work essential for the desired reduction in size, we 
applied force which we estimated at more than looo pounds, by 
means of a lever, and drew the fetus away. However cruel 
some operators might consider the operation, the animal did well. 

We doubt very much indeed if she could have done any bet- 
ter, or even if she would have suffered less had we further re- 
duced the size of the fetus by a very tedious and difficult 
operation. 

Other similar experiences might be cited, but what we wish to 
insist upon most strongly is that, if such great force is to be ap- 
plied for the extraction of a fetus, it should first be brought into 
a natural position so that in its passage all the soft tissues will 
be pressed iipon alike and that consequently the danger of pre- 
dominant pressure upon one area is reduced to a minimum. 

In the application of powerful traction, the operator should 
take particular care to properly command the direction and 



Repellers and Repulsion 595 

amount of force which is applied. In some cases it is essential to 
fix the animal's body so that it shall not be drawn from its posi- 
tion instead of the fetus being extracted, while in other cases it 
is necessary that the body of the parent be fixed in order to per- 
mit of the traction being applied in the desired direction. 

As a general rule, when severe traction is applied the animal 
assumes the recumbent position, and, when the fetus is well ad- 
vanced in the pelvic canal, it may be necessary to in some way 
fasten the posterior part of the body of the mother so that, when 
the traction is directed toward her feet, she is not constantly 
moved from her position. In order to overcome this movement 
of the body of the mother, we may in the mare fix a rope to the 
tail and, by attaching it to a solid object, prevent the constant 
slipping of the body in a ventral direction. In either the cow or 
the mare, a long rope may be passed between the hind limbs or 
around the buttocks somewhat below the vulva and then attached 
to some solid object beyond the dorsum of the mother in such a 
way as to prevent her gliding in a ventral direction. 

Repellers and Repulsion. 

In obstetrical operations it frequently becomes essential that 
the fetus be pushed back into the uterine cavity or the abdomen, 
in order that room may be obtained in which to make certain 
changes in the position of parts or to carry out other operations 
which may be essential to the extraction of the fetus. This pro- 
cedure we know as repulsion or retropulsion. It may be carried 
out in a variety of ways, and naturally the most primitive method 
is that of pushing the fetus backward by means of the operator's 
hand. This most primitive and simple of all methods has great 
advantages over the others, especially because the force can be 
applied with intelligence and safet}'. 

It is the most effective means for bringing about changes in 
the location and direction of the fetus, because the force may be 
constantly applied at the proper angle and may be at once modi- 
fied according to any changes in the position of the fetus during 
the progress of the operation. 

Manual repulsion has the great disadvantage that it places upon 
the operator the full burden of a more or less difficult task and 
makes a demand upon his physical resources, which may later be 
sorely needed for the accomplishment of other important opera- 



596 ' Veterinary Obstetrics 

tions. In harmony with the rule which we have already sug- 
gested, that the operator should delegate to other persons what- 
ever they may safely and properly do, leaving him to direct the 
application of force, various appliances have been introduced 
to relieve the obstetrist from the physical strain involved in this 
operation. 

Some obstetrists have an assistant push against the operator's 
shoulder or, grasping his arm, push it forward so as to increase 
his power in that way, but, however great additional force he 
may secure in this manner, the impact still falls wholly upon the 
operator's hand and tends finally to produce fatigue. 

Another plan is to have an assistant insert his hand and arm 
alongside that of the operator and the two push unitedly against 
the fetus, but this does not give the very best results because the 
room for working with the two arms in the pas.sages is not very 
ample and the two persons are somewhat in each other's way. 
In attempting this method of repulsion, the assistant stands with 
his back to the back of the operator, and, if the operator is using 
his right hand, the assistant inserts his left hand. 

More commonly and preferably the extra force is applied by 
means of instruments, usually by a repeller or crutch. Fig. 94. 
This instrument is shaped somewhat like a crutch and is made 
of wood, iron or steel, of variable size and form, usually about 30 
to 36 inches in length. Cleanliness and neatness dictate that 
this instrument should be made of steel, which is to be well pol- 
ished and then plated with nickel so that it will not rust. 

The crutch, or repelling end, is usually made solid and de- 
scribes the segment of a circle. It is made of varying width, and 
most of the instruments are very much larger than is necessary 
or desirable. 

Instruments made of good steel, ^ inch in diameter, are abun- 
dantly strong for all the force which one will have occasion to 
apply, and the length of the crutch itself should not exceed 4 
inches, while 3 inches is quite ample for all purposes. Some 
make them very much wider than this, with the idea that they 
may thereby secure a safer hold upon the fetus and thus do away 
with the liability of the instrument slipping off and injuring, the 
mother. 

In our experience there is no occasion for a repeller to slip from 
its point of fixation, if properly made, appHed and guarded. If 



Repellers and Repulsion 



597 



the instrument has too great a diameter, it is exceedingly diflS- 
cult to introduce and may cause injury to the soft parts of the 
mother while being applied. After it has been located at the 
proper point and force applied to it, if the transverse diameter of 
the crutch is very great, the ends may project beyond the parts 
of the fetus to which it is applied, catch in the walls of the uterus 
or vagina and more or less seriously injure them. We therefore 
prefer a repeller with a very short crutch, or transverse piece, 
which may be readily introduced completely covered by the hand 
and easily applied to the desired part of the fetus. 




Fig. 



REPEI/IvERS. 



a, Wither's repeller. (Sharp & Smith) d. Cup -shaped repeller of Binz. 

b, Hinged repeller. (Hauptner). 

c, Reiiidl's repeller with attachments e, Giinther's repeller. (Hauptner). 

(2 and 3 pronged repellers, blunt f. Kaiser's repeller with two detach- 
and sharp hooks, and vaginal able repellers and one cord carry, 

dilator). (Hauptner). ing hook. 

In a large proportion of cases where repulsion is desired, the 
fetus is dead. In such we use a repeller having a sharp spike in 
its center, Figs. 94 a and. 106 e, which sinks into the tissues of 
the fetus and gives the instrument a secure hold. 

If the fetus is alive, the .small spike, passing into the soft tis- 
sues, produces an aseptic wound, which heals without inflam- 
mation and without requiring material attention, so that it is not 



598 Veterinary Obstetrics 

highly objectionable. In order to overcome any such objection, 
however, the spike should be detachable and, in case the fetus is 
alive and the spike not absolutely necessary to secure fixation of 
the instrument, it may be unscrewed and removed and the instru- 
ment used without it. 

When using any type of repeller, the hand of the operator 
should constantly accompany the end which is in contact with 
the fetus during the entire operation of repulsion, and thereby 
guide the direction and amount of force and guard constantly 
against itsslippingordoinginjury toadjacentparts. When the re- 
pulsion has been accomplished and it is desired to hold the fetus in 
its position while the operator carries out some change in the po- 
sition of an extremity or brings about some other modification 
in position, it is allowable to take the hand away from the instru- 
ment and instruct the assistant to press steadily upon it. The 
party handling the repeller must be prepared to immediately 
withdraw his force, and even the instrument, in case there is any 
suspicious change in position of the fetal body, especially if it 
seems to yield in such a way as to suggest that the instrument 
may become displaced. 

Some obstetrists condemn the repeller as a dangerous instru- 
ment, but we have not found it so in any case. We consider 
that the repeller should be used in most cases where repulsion is 
desired and that the operator must, as a rule, abstain from using 
his 6wn power for bringing about this movement of the fetus 
when others may do it quite as well or even better if he will but 
place the instrument securely against the desired portion of the 
fetus and, accompanying it constantly with his hand, direct the 
force of the assistant or assistants. 

In the repulsion of the fetus it is essential that the uterus should 
be extended somewhat in order for its contents to move backward. 
Consequently, whenever force is applied to the fetus with the 
idea of pushing it backward, it almost inevitably arouses more or 
less vigorous expulsive efforts, which tend to prevent the desired 
repulsion. Whenever these expulsive efforts come on, little pro- 
gress, if any, can be made in the operation, and the operator must 
wait until the expulsive efforts cease and then, by a prompt 
thrust, push the fetus away toward the anterior end of the uterus. 
During the expulsive efforts, however, the operator should at- 
tempt to prevent the fetus from being driven toward the pelvis or 



Instruments for Section 599 

into it, by maintaining a steady pressure in the opposite direction 
and then being ready, as soon as the expulsive efforts relax, to 
quickly accomplish the results which are desired. 

Instruments for Section. 

Traction and. repulsion, with any accompanying changes in 
the position of the fetus, cannot always bring about a sufficiently 
favorable position of the fetus or other essential conditions to al- 
low of its extraction whole. Consequently the operator is fre- 
quently compelled to diminish the size of the fetus by removing 
one or more parts so as to permit of its easy passage through the 
birth canal. For the carrying out of embryotomy, a greater 
variety of instruments has been devised than for any other 
obstetric purpose. 

Each operator has his own preference in the selection of his 
means for bringing about these ends, and for each operator those 
instruments to which he is accustomed may be the best because 
there is no place in the realm of surgery where familiarity with 
an instrument constitutes so great a part of its value to the oper- 
ator as in embryotomy. 

Knives. First and most important in this group of instru- 
ments are the knives, of which we have an infinite variety offered 
by the various instrument makers. We may divide these into 
two great classes ; the finger-knife, and the short-handled knife or 
scalpel. 

The finger-knife, Fig. 95, which is attached to one of the 
fingers bj' means of one or two rings, is one of the simplest and 
most effective of all embryotomy section instruments, and is per- 
haps the most universally used. It is made in various shapes, 
according to the individual preferences of the operator. Most fre- 
quently it consists of a somewhat narrow blade which is curved 
downward. The blade may advantageously be hooked for aU 
tho.se operations where it is desired to make a long, drawing cut, 
by inserting the hand to the point where we wish the incision to 
begin and then making the cut as the hand is drawn outward. 
In such a case the hooked knife sinks into the tissues automa- 
tically and the operator simply keeps his hand against the surface 
which he wishes to cut and draws it outward. 

Finger knives, as made by most instrument dealers, are too 
long for the average operator and cannot be easily handled. The 



6oo 



Veterinary Obstetrics 



operator with a small hand cannot guard the ordinary finger- 
knife in such a way that he can readily introduce it to the point 
where he desires to work. We have been compelled to have 
finger-knives constructed to order, because of this difficulty. 
The blade of the finger-knife should be of such a length that, 
when it is placed upon the finger, the hand can close about it in 
such a way as to protect the point completelj^ with safety alike 
to the operator and to the patient. 




Fig. 95. 

a, Full-curved obstetric knife. 

b, Half- curved obstetric knife. 

c, Karl's embrj^otomy knife. 

d, Giinther's embryotomy knife. 



Finger Knives. 



Vienna embryotomy knife. 
Danish embryotomy knife, with 

detachable blades of various 

patterns. 



The types of these finger-knives, Fig. 95, are exceedingly vari- 
able, but the simpler ones a and b, are perhaps as efficient as any 
after the operator once becomes accustomed to them, though we 
would not say they are superior to the many other types. These 
instruments admit chiefly of incisions in a line parallel to the long 
axis of the operator's hand and arm, and cannot very well be used 
for section in a transverse direction. If we take one of the finger- 
knives with but a single ring, which is larger than the finger, it 
maj^ be turned more or less obliquely across the hand and, by 
bending the hand somewhat also, we may be enabled to make a 
transverse incision. 

Scalpels. We also find a very extensive list of scalpels or 
bistouries with straight handles, the blades of which may be 



Instnonents for Section 



6oi 



either naked or concealed. In some cases the blade is concealed 
within the handle, and in others hy a moveable guard alongside 
the blade. 

The concealed types have a tendency to become swollen and 
refuse to work after they have been immersed in liquids 
for a time, especially those with wooden or bone handles. 
This criticism does not apply when the instrument is constructed 
entirely of metal. A very good type of the concealed knife is 
that of Kauffman, Fig. 96 e, f. An equally convenient type of 
knife, which to us seems even superior, perhaps because we are 
more familiar with it, is the Colin scalpel, Fig. 106 b, and as in 
other cases we greatly prefer that the instrument be constructed 
wholly of metal so that the guard will not become caught because 
of swelling of the handle. 





Fig. 96. CoNCEAi,ED AND Guarded Knives. 

a, b, c. Concealed knife of Giintlier, d, Concealed knife of Deutscii. 
with convex, concave and double e, f, Guarded knife of Kauffman, 
edged blades. with convex and hooked blades. 

The advantage of the scalpel over the finger-knife is that it 
may be turned in any direction, so that an incision may be made 
longitudinally or transversely, as the operator may desire. It has 
been suggested that an objection to this kind of knife is the pos- 
sibility of losing it in the uterus, but in our clinical experience 
this objection is not well grounded. To guard against such a 
possibility, some of these instruments are made with an eye at 
the extremity of the handle, through which a safety cord may 
be passed so that the instrument, if lost, may be recovered. 



6o2 



Veterinary Obstetrics 



It is important that such scalpels be made very short and the 
handle be of such a character as to afford a firm hold. Such a 
knife should not exceed 4 inches in length, so that it may readily 
be concealed in the hand and carried to any part of the uterus. 

Long Cutting Hooks, Sectors and Embryotonies. In ad- 
dition to the finger knives and scalpels, there has been devised a 
great variety of larger instruments for section or other divisions 
of the fetus, known as long cutting hooks, sectors, embr3'otomes, 
etc. 



a 




Fig. 98. 



Fig. 97. Long Handled Cutting Instruments. 

97, Embryotome of Dopheide. (Harms). 98, Sharp cutting hook ofWithers. 

The Long Cutting Hooks consist of long- handled hooks 
with the concave face of the hook consisting of a cutting edge, as 
in Fig. 98, or h in Fig. 106. The cutting end is introduced to 



Instruments for Seettoti 603 

the desired point carefully guarded by the operator's hand and a 
drawing incision is made as the instrument is withdrawn, the 
operator's hand still accompanying the hook and controlling the 
extent and degree of the cut. The sharp pointed ones are very 
dangerous to handle, and if they are to be used at all ihe hook 
should be very small and short, so that it can be easily guarded. 
The long, stiff handle makes it exceedingly diiBcult to safely 
guard the instrument while it is being introduced, so that any 
violent expulsive efforts or accidental movements of the mother 
are liable to cau.se a displacement of the instrument, with painful 
consequences to the hand of the operator or to the uterus of the 
mother. 

The objections are overcome in some of these instruments by 
making the hook probe-pointed, like in h Fig. 106. This instru- 
ment is easily and safely handled and proves highly Uiseful 
wherever it may be applied. The obstetrist may readily sever 
the fetal ribs with it after evisceration, or may divide the pelvic 
symphysis, or the pelvic girdle at other points, or accomplish other 
operations. They cannot be used for cutting the skin unless an 
incision be first made, through which the probe or sphere may 
be introduced. 

Embryotomes. The group of instruments known as embry- 
otomes are of great variety in design and purpose. Some of the 
simpler ones do not differ essentially from the cutting hooks. 
The embryotom of Dopheide, Fig. 97, consists essentially of a 
closed knife attached to a long and rigid handle. When introduced 
to the part upon which it is desired to operate, the instrument 
opens automatically when the operator begins to withdraw it, 
and may thus serve to cut deeply and freely through the soft 
tissues. In case it is desired to stop the incision at a given point, 
it is simply necessary to push the instrument backward again, 
when it closes, and can be grasped by the hand of the operator, 
which has been in contact with it at all times, and be easily with- 
drawn. 

The embryotom of Oehmke, which appears to be a very prac- 
tical instrument, has a lance-like blade which is exposed by press- 
ing upon a spring with the index finger and is kept exposed as 
long as the pressure is continued. 

Most embryotomes, Figs. loi and 102, con.sist of more complex 
machines, designed to cut, crush or tear through any portion of a 



6o4 



Veterinary Obstetrics 



fetus to which they may be applied, whether the tissues be soft 
or hard. They have been used in obstetric practice for a great 
many years, but have not acquired a very wide application. 

They con.sist in many cases of two powerful, sharp blades ope- 
rated as shears by some mechanism which gives them sufficient 
power to cut through an extremity at any point where it may 
be grasped. Sometimes the instrument is constructed somewhat 
on the plan of an ecraseur, and by some mechanical appliance 
a sharp chain is forced through the tissues. Representing this 
type of instrument, which has recently become quite popular 
in Germany, is the Pflianz embryotome, Fig. 99, and the Pflanz 
extractor, Fig. 100. 




Fig. 

Figs. 99-102. Embryotomes, etc 

99. Pflanz' embryotome (Hauptner) loi. Obstetric shears (Haussman). 
100. Pflanz' extractor ( Hauptner). 102. Cullen's embryotome. 

The former consists of a heavy frame-work which might be 
likened to that of an ecraseur, with an ordinary strong chain, 
which is passed around the part of the fetus to be divided. By 
drawing upon this, the sharp chain or sector is brought in contact 
with the part to be amputated and forced through the soft tis- 
sues and bone. 



Instruments for Section 605 

The instrument is said to be highly effective, but according to 
reports by some of those who are its most enthusiastic admirers, 
it frequently cannot be applied to a part which is to be ampu- 
tated. The instrument weighs approximately 10 pounds, and is 
consequently quite cumbersome to handle. Its expense is about 
$30 in America. 

Similar objections apply to other embryotomes. They are so 
large and heavy that they are exceedingly difficult to introduce 
into the genital passages and, once this has been done, the part 
which is to be amputated must present in a position essentially 
perpendicular to the long axis of the pelvic canal, since otherwise 
the instrument cannot be applied to it. 

Aside from their expense, their cumbersomeness in carrying 
and the difficulty or impossibility of applying them to the desired 
part, they are exceedingly difficult to properly care for and dis- 
infect. When once applied, their action is generally satisfactory, 
if not ideal. The extractor of Pflanz, Fig. 100, is designed 
through its powerful mechanism to tear away a fetal limb, the 
ring at the distal end receiving the entire impact of the tension 
upon the limb by the chain, thus relieving the maternal parts 
from any pressure whatever. 

Chain-Saws. Somewhat closely allied to the embryotomes 
are the chain-saws, like that of Persson, Fig. 103 a, or the chain 
sector of Masch, Fig. 103 b, which have been recommended for 




Fig. 103. Obstetric Saws and Sectors. 

a, Persson's obstetric saw. b. Chain sector of Masch. 

c. Obstetric saw of Ohmke. 

the same purposes as the embyrotomes and are operated by being 
passed around the limb or neck of the fetus which is to be 



6o6 Veterinary Obstetrics 

amputated and then drawn back and forth in a sawing man- 
ner. They are effective in their work and in some cases offer 
special advantages, but on the whole they have not come into 
general use. They are comparatively expensive, rather difficult 
to apply, are not very rapid iu execution, and are exceedingly 
difficult to maintain in aseptic and working condition. 

Stiff-handled obstetric saws are also recommended by some 
practitioners. Short finger saws, with short handle and finger- 
ring like c. Fig. 103, are recommended by some, but they have 
little efficiency in most cases because wholly dependent upon the 
inserted hand, tightly compressed and largely powerless, for anj' 
use. Long handled saws are more workable because the saw can 
be guarded with the inserted hand and the force applied with 
the free hand. Thej' can be used in no operation and applied to 
no part for which the obstetric chisel is not equally efficient and 
safe. We have repeatedly attempted the use of chain-saws, 
sectors, and stiff handled saws, and have always laid them aside 
as greatly inferior to chisels. 

Obstetric Chisels. The simplest and most effective imple- 
ment for section of fetal bones is the embryotomy chisel, which, 
like other instruments, is constructed in a variety of forms. We 
use a chisel. Fig. 106 d, mafie of the best steel, of % or y% inch 
diameter, and about 30 inches in length, with the chisel end 
about 2 inches wide and tapering gradually backward toward the 
handle for a distance of 4 or 5 inches. The chisel blade is about 
yV to % in. thick, so that it may safely pass through the hardest 
bone in the fetal body, and the cutting edge of the chisel is made 
slightly concave in order to render it less liable to slip to one side. 

Such a chisel is readily kept in order and is easily applied by 
the operator to any portion of the fetus which is within his 
reach. Grasping the chisel blade in his hand, he carries it to 
the part to be operated upon and, placing the instrument in the 
best direction possible, against the part, he instructs an assistant 
to drive it through the tissue with a mallet or hammer. When 
driving the instrument through bone, it should be forced but a 
short distance at a time, then loosened and perhaps revolved on 
its long axis in order to pry the bones apart and also to avoid 
driving the chisel too far and having it become caught in such a 
way that it is difficult to remove it. 

In amputating a limb, the chisel should not be placed upou its 



Inst7-ume7its for Section 



607 



center, but at one side, so that it will cut completely through the 
tissues on that side to which it is applied, and not be driven 
clear through the limb with some of the tissues intact upon either 
side and thus be caught and held as though in a vice. 

Such an instrument is cheap, is easily and safely applied by 
the operator to any point within his reach, can be readily driven 





Fig. 104. Obstetric Chisels. Fig. 105. Spatulas. 

a, de Bruin's vertebra knife. a, Spatula of Harms. 

b, de Bruin's embryotomy chisel. b, Spatula with handle. 

c, Withers' embryotomy chisel. c, Small spatula of deBruin. 

d, Curved spatula of de Bruin. 

through any tissue of the body whether soft or hard, has little 
tendency to break or get out of order, is easily kept clean, and 
will accomplish any task in embryotomy which can be performed 
by the chain-saw, by the Pflanz embryotome or by any machine 
however complicated or expensive. It can be applied to any 
part where the other instruments can and in many places where 
they cannot be at all, or only with very great difficulty. In the 



6o8 Veteri7iary Obstetrics 

amputation of the pelvis and posterior limbs, in the breech pre- 
sentation, it is the instrument par excellence. In the amputation 
of the limbs it is quicklj' applied and safe, and its work is rapid 
and efficient. Other types of obstetric chisels, all efficient, are 
shown in Fig. 104. 

Supplementary- to these instruments for section, there have 
been introduced and recommended by various operators a group 
of blunt, flat instruments known as spatulse, which are designed 
primarily for the purpose of separating the skin of the fetus from 
the subjacent tissues. They have a degree of merit, and aid con- 
siderablj' at times in hastening the operation of detaching the 
skin from the fetus, and thus facilitate an early completion of 
the operation. Like all the other instruments thej' are made in 
a great variety of types. Some of the most useful of these are 
shown in Fig. 105. They are not essential, but rather auxiliary, 
and their place may well be taken by other instruments. 
The chisel, which we have already described, answers quite well 
the purpose of a spatula at any points where the resistance may 
be very great, while elsewhere we are in the habit of using the 
thumb or fingers or the entire hand for separating the skin from 
the under-lj'ing parts. 

General Observations Upon the Construction of 
Obstetric Instruments. 

We have already suggested casually that obstetric instruments 
should be of such a character as to render them easil}' cleaned. 
In our personal experience we have found that instruments are 
most readily kept in order when thej' are constructed of a good 
qualit}' of steel, highh' polished and nickel plated. Such instru- 
ments are not readily attacked bj' rust, are verj^ clean and pre- 
sent the smoothest possible surface, so as not to irritate the 
genital organs. The instruments should be as smooth and well- 
rounded in all their parts as is practicable, not onlj' that they 
may work more readily, but also that there may be less oppor- 
tunity for the collection of dirt at anj- point, which may interfere 
with their operation or constitute a bearer of infection. This 
naturally suggests that the instruments should be of the simplest 
character consistent with efiiciency and that screws, joints, links 
and chains should be avoided whenever and wherever practicable. 

There has recently entered into veterinar}' practice, in both 



Construction of Obstetric Instrunie7its 609 

Europe and America, a strong tendenc}' to the construction of 
sectional instruments which may be unscrewed and consequently 
occupy a small compass, or rather a shorter space, than if made 
solid in a single length. It must be granted that such instru- 
ments admit of being placed in a more compact case, and this is 
really the only advantage which can be claimed for this plan of 
construction. 

The plan possesses many disadvantages. The jointed instru- 
ment is inevitably weaker than the solid one, and must be made 
heavier in order to compensate for the joint. The joint, espe- 
cially the female screw, constitutes an ever present danger from 
the standpoint of infection and renders the instrument exceed- 
ingly difficult to clean. One of the most serious objections to 
the obstetric instrument with a screw joint is its inefficiency at a 
critical moment. An operator works for a long time to apply an 
instrument at the proper point in order to accomplish a certain 
purpose, and, just as he is ready to do his work, a sudden move- 
ment of the animal, or other cau.ses, leads to an unscrewing of 
the instrument. His time and labor have been wholly lost ; the 
instrument must be withdrawn and the screw joint tightened 
and the operator must begin over. 

It is a custom also, of the instrument makers, to fit a series of 
obstetric instruments to one handle hy means of a screw, with 
the idea that they thereby render the outfit cheaper, lighter and 
more compact. This plan has a very serious disadvantage in 
reference to efficiency in practice. Convenience in carr3'ing an 
instrument should be subordinate to the question of efficiency 
when the operator has reached his case. If he has been using 
an adjustable handle with a hook, and finds that he would like 
very much to have a repeller instead, he will perhaps find the 
hook so tightly screwed fast that he cannot release it and must 
ask some bystander with dirty hands to unscrew it for him. In 
the meantime delay of an important character may have occurred, 
and the position of the fetus may have undergone unfavorable 
change. 

He may desire to hold a certain part with the hook while 
he uses the bone chisel or some other instrument, and he is with- 
out a handle for the other, so that he cannot simultaneously use 
the two. At ever}' point the plan of a universal handle for all 
obstetric instruments is wasteful of time and detrimental to effi- 
39 



6io Veterinary Obstetrics 

ciency. After all, the gain in reference to compactness is not 
very great. If the instruments are solid throughout their entire 
length, the case or roll to contain them is necessarily longer, but 
need not be so wide nor so thick, and the actual cubic space oc- 
cupied by them is not changed. The weight is no greater with 
the solid instrument than the jointed one. It is therefore a 
question of the form of a container and not of its cubical con- 
tents or weight. We are therefore strongly in favor of a solid 
instrument, believing that with it the veterinarian can do more 
rapid, more efficient and safer work. 

The handles of obstetric instruments are variously formed and 
have certain advantages in their structure. In our judgment 
and experience, the most efficient handle is that consisting of an 
oval ring of sufficient size for the insertion of a man's hand, or 
we might say of a width of 3^ inches. The advantage of such 
a handle is that it gives a secure hold, through which the opera- 
tor may exert his full force in any direction that he may wish, 
and supplies a form of handle which is not readily caught or en- 
tangled upon surrounding objects. With this ring handle, the 
operator or an assistant can exert his full power either in repul- 
sion or in traction, or maj^ revolve the instrument upon its long 
axis or push it in any direction. The revolving of the instru- 
ment upon its long axis is frequentlj^ of supreme importance in 
obstetric operations, and one needs have a secure hold in order 
to accomplish this movement. 

It is especially important to be able to rotate a chisel upon its 
long axis when it is being driven through bones and it is desired 
to break apart and separate the bone which has been only par- 
tially divided. It is also highly important that the operator or 
assistant shall be able to revolve the instrument upon its long 
axis in case he is attempting to implant a hook in a given part. 
The repeller also is much safer if the operator or assistant can 
control it completely and either turn it upon its long axis or pre- 
vent it from turning, as demanded. The other forms of handle 
ordinarily seen in obstetric instruments are the straight or olive- 
shaped handle, usually of wood, and the bar or transverse handle, 
usually of metal. The olive-shaped handle is in many respects 
the neatest and occupies less space in a container, but it is de- 
cidedly wanting in efficiency as compared with the ring handle. 



Obstetric Outfits 6ii 

The bar handle is efficient, but we believe it less convenient for 
grasping than the ring, and the projecting bars tend to catch 
against objects. 

Obstetric Outfits. 

We have already asserted that the veterinarian should have 
ready at hand an outfit for obstetrics, which he can secure 
promptly upon the receipt of a call, knowing that he will have 
in his possession every instrument and appliance or other ma- 
terial which the exigencies of difficult labor may demand. Instru- 
ment makers in many instances prepare sets of obstetric instruments 
in neat cases, which are very convenient in so far as the instru- 
ments themselves are concerned. They contain, as a general 
rule, an extensive array of instruments which, in many cases, are 
better fitted to impress the bystander than to accomplish efficieUt 
work. The obstetrist's outfit need not be expensive nor consist of 
a great number of instruments or appliances. We would suggest, 
as a simple outfit of instruments, the following articles, as shown 
in Fig. io6 : 

I. Two % inch cotton cords, two ^ inch cotton cords, one ^ 
inch' cotton cord, each 4 or 5 feet in length, with a pre- 
pared loop at one end, and the other securely wound with thread 
to prevent untwisting ; 2. long, blunt hook ; • 3. short blunt hook ; 
4. chisel ; 5. repeller ; 6. finger-knife ; 7. scalpel ; 8. injecting 
pump. We use a small pump to which is attached a pure gum 
horse stomach tube to serve as tube and nozzle. The apparatus 
is simple, easily cleaned, withstands boiling perfectly, and the 
distal end of the tube is sufficiently rigid to serve all purposes of 
a nozzle, while so pliable, well-rounded, smooth and soft that it 
cannot well injure even very delicate tissues. The horse stom- 
ach tube with an ordinar}' funnel makes an excellent gravity in- 
jector, in some respects preferable to the pump. It is quite as 
efficient and durable, is cheaper, and lighter to carry. 

These instruments we would have placed, in an orderly manner, 
in a compact case of metal (tinned copper) or in a canvass roll, 
so that we could at any time thoroughly disinfect the case, either 
with or without the instruments, by immersing it in an antiseptic 
fluid or by boiling. The tinned copper case could be filled with 
hot water and placed upon a stove, where it could be boiled for 
any length of time desired, and both the case and contained in- 
struments rendered thoroughly sterile. 



6l2 



Veterinary Obstetrics 



If it is desired to protect a metal case of this character in hand- 
ling and carrying, it can be enclosed in a canvass jacket. In ad- 
dition to the instruments which we have suggested here, the vet- 
erinarian may readily add others, which he can include in the 
same case if he desires, and which may in his experience possess 
a very high value which would fully warrant their use. 

For a number of years we carried a list of instruments consid- . 




Fig. io6. Obstetric Set. 



a, Aseptible tinned copper case. 

b. Tray containing i short blunt hook, 
I Colin's scalpel, i curved finger 
knife, and i straight finger knife. 

c, Enema pump, with pure gum stom- 
ach tube instead of customary tube 
and nozzle. 

d. Embryotomy chisel. 



e, Repeller with detachable spike. 

f, Curved cord carrier which may be 
used as a blunt hook. 

g, Long blunt hook. 

h, L,ong-haudled cutting hook with 
probe point, for severing ribs and 
pelvic bones. 



erably in excess of those which we have here designated, but 
from time to time first one and then another was discarded or 
left unused, until finally they were narrowed down to the very 
brief list which we have here suggested. 

In addition to this outfit of instruments, there are other neces- 



Obstetric Outfits 613 

saries which the veterinarian should always carry in cases of 
dystokia, but which we would prefer to not include within the 
instrument case, but would carry in a second container. This, like 
the instrument case, should be of a construction which would 
render it capable of complete and thorough disinfection or sterili- 
zation, and to this end we would have it constructed, like the 
other, of canvas or of metal. In it we should carry : clothing 
for the operator ; disinfectants, including creolin, lysol and 
iodoform ; anaesthetics ; general operating instruments, includ- 
ing a trachea tube and trocar ; hj'podermic syringe ; strychnine 
ergotine or other hypodermic remedies. 

In the experience of different practitioners, other apparatus or 
materials may be suggested. Some of the German operators aim 
to carry with them constantly some form of truss or bandage to 
prevent prolapse of the uterus or vagina after parturition, while 
others advise the carrying of an obstetric pulley or other means 
for developing mechanical force. 

The Dress of the Operator. 

In dressing for au obstetric operation, the veterinarian should 
have due regard for his personal health and comfort, for the 
safety of himself and the animal from infection, and for conven- 
ience and economy. He is quite unwarranted in going into 
work with dirty clothing, which may be the bearer of serious in- 
fection for the mother, and is equally unwarranted in ruining 
expensive clothing in the course of his work. 

The habit of some veterinarians of wearing overalls which have 
been used in general work and have been befouled with dis- 
charges from suppurating wounds, putrid afterbirths or in pre- 
vious cases of parturition, without having been thoroughly 
washed and cleansed, cannot be too strongly condemned. 

Two features should be considered in the question of clothing. 
It should afford the obstetrist ample protection from cold and 
wet, and should be scrupulously clean. Whenever the weather 
and surroundings will permit, one of the most convenient and 
efficient methods for operating is for the practitioner to strip to 
his waist line, and whenever conditions will not warrant this he 
should, after stripping, put on a white blouse without sleeves, 
which has been thoroughly washed and boiled and is at least 
practically, if not technically sterile. If it is necessary for his 



6 14 Veterinary Obstetrics 

comfort that he shall wear still more clothing about his chest, it 
should consist of cotton under-clothing without sleeves. 

One may work fairly well in a blouse with long sleeves by 
rolling them up, but the rolled sleeves soon become saturated 
with discharges from the animal and probably annoy the opera- 
tor also by becoming unrolled. Moreover, the roll interferes to 
some degree with the reach of the arm, and the operator cannot 
bring the shoulder in so close contact with the vulva of the 
patient. 

Some writers upon obstetrics advise the use of woolen instead 
of cotton clothing and speak especially of a warm woolen jacket, 
but this material is difficult to cleanse because it will not with- 
stand boiling. The operator is consequently forced to resort to 
the use of disinfectants which maj' prove more or less inefficient 
for the purpose desired. 

The protection of the lower parts of the body from the waist 
down offers a problem which varies greatly under different con- 
ditions. In protracted cases of dystokia, ordinary overalls of 
ducking fail to protect the operator's clothing, and he becomes 
quite wet. 

Occasionally also the operator must kneel ^r lie down behind 
a recumbent animal in a place which is none too clean, with the 
result that, with any form of pervious clothing, he is soon sat- 
urated to the skin. To guard the operator in these respects the 
best plan that we have found is the wearing of rubber trousers, 
which are highly efficient for the purpose and are reasonably 
cheap and durable. These trousers, made of rubber cloth, are 
quite impervious to fluids of every kind, so that one can kneel, 
sit or lie in any position behind a recumbent animal with im- 
punity. If to these we add rubber boots, the operator is in a 
position to thoroughly protect himself and to come out of the 
worst and most repulsive d5'stokia reasonably clean and com- 
fortable. The rubber trousers and boots have the disadvantage 
of not being very resistant to some antiseptics. A strong solution 
of carbolic acid may ruin the fabric. However, they will with- 
stand a moderately strong solution of antiseptics with comparative 
impunity, and wash so easily that they can be quite thoroughly 
cleansed in a mechanical way. They may be quite well disin- 
fected after use with a solution of corosive sublimate, or still 
better with formalin. 



Positio7i and Control of Patie^it 615 

Position and Control of the Patient. 

One of the most disagreeable features to the veterinarian is the 
surroundings in which he finds his patient and is compelled to do 
his work. In many cases this is inimical to his comfort and 
health, and it is sometimes a question how far it is proper for 
him to ignore these factors in the course of his professional du- 
ties. It is clearly the duty of the owners of animals to provide a 
comfortable and proper place in which the veterinary obstetrist 
may work, and it is clearly not the duty or function of the veteri- 
narian to ignore comfort beyond a reasonable degree. 

Sometimes a stable is exceedingly cold, but this, as a rule, does 
not seriousl)' discomfort the veterinary obstetrist, since once he 
is engaged in his work he can usually keep warm, and it is less 
difficult and disagreeable for him than for the bystanders, but 
even this discomfort should not be carried too far. The veteri- 
narian is entitled to demand a reasonably comfortable place for 
his work. 

Sometimes the place for his work is disagreeably hot, and we 
have suffered at times from working upon a recumbent animal in 
the bright sunlight, our arms having been badly blistered by the 
sun's rays. Clearly it is the duty of the owner of an animal in 
such a position either to provide some means for transporting it 
elsewhere or a shade for the protection of the operator during 
the work. 

In many cases we find the animal affected with dystokia con- 
fined in an exceedingly filthy place, where we cannot touch any- 
thing without becoming begrimed with dirt. The veterinarian 
should demand that such a place be cleaned up, and that appro- 
priate tables or other conveniences be supplied upon which his 
instruments and apparatus can be placed, where they can be 
handled without getting them befouled. In other instances, the 
stall or stanchion is wet and filthy from feces and urine. The 
practitioner should demand that the filth be removed and an 
abundance of clean, dry straw or hay supplied to cover over the 
floor of the stall and surrounding parts where the work must be 
done. 

Sometimes the room is inadequate, so that one cannot operate. 
The room may even be unsafe, as when an upright post stands 
in close proximity to the rear end of the patient, so that in case 



6i6 Veterinary Obstetrics 

of lateral movements the operator may be caught between the 
post and the patient and his arm more or less seriouslj' injured. 
In other cases a cow suffering from dystokia may be confined in 
a stanchion with a deep gutter behind her, and this ma}' form a 
constant menace to the veterinarian, if he makes a inisstep. If 
an animal must be operated upon with such a gutter in close 
proximity, it should be securely covered over with boards in such 
a manner as to insure against accident, and over these there 
should be spread a goodlj' amount of clean bedding. 

If the room, where the animal suffering from d5'stokia is con- 
fined, is wholly inadequate for any of the reasons which we have 
mentioned or for others, the animal should be removed to a 
proper place for the work. If a mare or cow is able to walk, it 
is an easy matter to move her to another building, where rea- 
sonable comfort and convenience can be had ; but if she is re- 
cumbent it is still no bar to getting her into a comfortable place. 
If a goodl}' amount of bedding is thrown upon the floor, a cow 
or mare can be taken by 4 or 5 men for a few feet, or a few rods 
for that matter, without much delay or difficult3% if the veterina- 
rian knows how to control their efforts. For this purpose it may 
be necessary to demolish a partition or to take other action 
which may to some extent injure the owner's property or cause 
him some labor to repair, but the operator is entitled to such 
surroundings as will furnish him with a reasonable degree of 
safety and comfort and permit him to do his work in a way 
which will promise some hope of success. In many instances the 
obstetrist must put up with very numerous inconveniences, but 
these should be reduced to a minimum. 

The position of the pregnant animal during obstetric opera- 
tions is of fundamental importance. Generally, in the larger 
animals most operations can be best carried out with the patient 
in the standing position. In this position the abdominal floor 
slopes downward and forward below the pubis and the gravid 
uterus drops forward toward the diaphragm. This admits of 
more ready repulsion of the fetus, facilitates the correction of 
any deviations in its extremities, and favors the carrying out of 
most obstetric operations. 

Sometimes the animal, especially the cow, is exceedingly ob- 
stinate and refuses to stand even under the greatest punishment. 
It is usually of little use to lift the cow by force, because she 



Position and Control of Patient 617 

absolutelj' refuses to try to stand. If slings are placed under her 
and she is raised by means of pulleys, she still thwarts the ob- 
stetrist's aim b^' lying limp in the apparatus and producing the 
same or even worse conditions than though she were lying down. 

The most efScient method of getting an obstinate cow to stand 
is by means of a well-trained dog. When such a dog is brought 
into the stall and will take hold of the cow in a vigorous manner, 
if she has enough strength to rise, she will get up very promptly, 
and, as long as the dog will stand by, ready to interfere the mo- 
ment she attempts to lie down, she will continue to stand as loug 
as she is able. It might not be an unwise plan for the veterinary 
obstetrist, with much cattle obstetrics, to regard a well- trained 
dog as a part of his obstetric equipment and have the animal ac- 
company him in all cases of dystokia, ready to render such a 
service. 

Some animals suffering from dystokia are vicious, and the op- 
erator must take precautions against injury from them. In 
carnivora it is wise to muzzle the patient before attempting any 
work which may induce any vicious resistance. In ruminants 
there is almost no danger to the operator because of any vicious- 
ness upon the part of the patient. Very rarely the cow may 
kick, but this we have not observed. 

It is very rare that the mare oifers any violent resistance to the 
work of the operator. Some have suggested that in all, or in 
most cases, an assistant should hold up the mare's forefoot, birt 
in an extensive experience among mares we have encountered 
only one which required any definite restraint in so far as vicious- 
ness was concerned. Almost always the mare stands quietly, or 
at most merely steps from side to side, and does not offer to kick. 
In the one exception in our experience we found it necessary to 
cast the mare and tie all four feet, because she persistently and 
viciously kicked and fought, and rendered our work both highly 
dangerous and wholly inefficient until she was thoroughly secured. 
The securing of the animal, by tying, compressed the abdomen 
and greatly increased the difificulty of our operation. The diffi- 
culty would have been largely obviated by general anaesthesia. 

Although the standing position is usually the most favorable 
one for operating, it is not uniformly so, and in some instances 
recumbency is preferable. 

Whether the recumbency is unavoidable or is brought about 



6i8 Veterinary Obstetrics 

by the operator for special reasons, the position of the recumbent 
animal is highly important. 

If, for instance, an animal is recumbent and there is a deviation 
of the fetal head toward the left side of the mother, it would be 
highly unfavorable for the operator, should the mother lie upon 
her left side, because the weight of the fetal body would thus be 
thrown upon its head. This would necessitate lifting the fetal body 
in order to correct the deviation of the head and bring it into the 
proper position. If the patient lay upon her right side instead, the 
fetal head would rest upon its body and it would be more readily 
extended. Hence in many instances it is desirable to change the 
attitude of the recumbent animal or even to cast the patient in 
order to effect certain manipulations or changes of position. Us- 
ually, when an animal is recumbent, she should be placed with her 
hind parts elevated, in order that the fetus may drop away forward 
toward the diaphragm, and afford increased room and facility 
for repulsion, changes in position or other desired operations. 
It is important generally that the recumbent animal should lie 
prone upon her side with all her limbs free and extended. 

It is very disadvantageous to the operator for the patient to 
lie upon her sternum, since this position causes undue pressure 
upon the abdomen and crowds the gravid uterus against or into 
the pelvis so tightly as to render repulsion well nigh impossible, 
and any other changes in the position of the fetus or the correc- 
tion of any deviation of an extremity very difficult. 

In order to elevate the hind quarters of a recumbent animal, 
extra bedding may be placed beneath the posterior parts to any 
degree desired. Sometimes advantage ma}' be taken of sloping 
ground, like a terrace, and we have placed such an animal in a 
door- way where the floor within was higher than the ground with- 
out. Padding the door well with straw, the cow is placed with 
her head outward and her buttocks in the stable, at a higher 
elevation. 

The elevation of the posterior parts may also be brought about 
by placing the recumbent animal upon a heavy door or on a 
platform of heavy boards, and raising that portion of the door or 
platform upon which the posterior portion of her body rests, sup- 
port it by means of blocks placed underneath. Usually, the 
greater the elevation of the posterior parts of the recumbent ani- 



Position of the Patient 619 

mal, the better for the operator. In order to prevent the patient 
from sliding down the incline, ropes may be attached to the hind 
feet, and held by assistants or attached to a post or beam. 

Even greater advantage may be afforded sometimes by placing 
stout ropes upon the hind legs, carrying them over pulleys at- 
tached to a beam above, and, turning the patient upon her back, 
more or le-ss completely suspend her with the head downwards. 
This causes the fetus, along with the rumen and other viscera, 
to drop forward by gravity, and affords room for version or other 
manipulations. The position cannot be maintained for a very 
long period. 

The question of the exact attitude of the patient during ob- 
stetric operations is to be determined in each case by the charac- 
ter of the obstacle to parturition. 



The expulsive efforts of the mother frequently constitute an 
important impsdiment to obstetric operations, and sometimes 
render an otherwise very trivial procedure exceedingly difficult, 
or impossible. Sometimes the slight deviation of a forelimb 
could be corrected in a few minutes if the patient would not 
strain, but under constant and violent expulsive efforts it may 
become a very laborious operation of long duration. So with 
many other manipulations. It is consequently important that 
we should understand and apply as fully as possible our means 
for controlling the expulsive efforts of the mother. 

In many cases the expulsive efforts can be largely prevented by 
attracting the animal's attention, either by frightening it some- 
what or by some physical punishment of a moderate character. 
In the mare a twitch upon the nose will sometimes tend to inhibit 
violent expulsive efforts. In other cases slight strokes upon the 
nose and lips with a strap, stick or rope will so attract her at- 
tention as to stop the straining. The owner may be able to 
attract her attention by gently stroking her with the hand, by 
moving the head up and down or otherwise keeping her atten- 
tion somewhat attracted by caressing her. 

The mare may also be largely prevented from straining by pinch- 
ing the back or loins with the fingers or by placing a stick of 
wood, especially one with square corners, across the loins, 
and having a man on either side press down upon the stick in a 



620 Veterinary Obstetrics 

way to cause pain when the animal attempts to arch her back 
during an expulsive effort. This plan is even more effective in 
the cow, or her straining may be overcome by tying a hard rope 
across the back in such a way that it will not permit her to 
elevate the spinal column in order to strain. For this purpose we 
use a coarse rope, attach one end near the floor on one side, 
carry it directly over her loins, draw it through a ring or around 
a post near the floor upon the other side, and make it fast at such 
a point that the cow's back cannot be raised above the normal 
level. 

It has been proposed to overcome the violent expulsive efforts 
of our larger domestic animals by means of tracheotomy. In 
this way the animal cannot strain so hard because of the fact that 
she cannot close the larynx and retain the air in the lungs, since 
it promptly escapes through the trachea tube. This cannot, how- 
ever, wholly overcome the expulsive efforts, but is worthy of 
trial. 

When these expedients fail, or we desire to wholly control the 
struggles and expulsive efforts of the animal, we may resort to an- 
aesthesia. We have resorted to chloroform anaesthesia in dys- 
tokia in the mare, with the best results, and feel that this method 
of control has been entirely too much neglected by veterinary 
practitioners. The veterinary obstetrist, especially when dealing 
with mares, should always carry a sufficient amount of chloro- 
form to produce anaesthesia, and should be ready to resort to it 
whenever the exigencies of the case, either from a humane or a 
surgical standpoint, may demand it. 

The Prevention of Infection During Obstetric 
Operations. 

There is no place in veterinary practice where the rules of dis- 
infection are more important than in obstetric work. Nowhere 
else do we encounter so large and highly receptive a surface for 
infection as in the uterus, denuded as it is of its protective epi- 
thelium at the time of birth. 

The operator should be provided, as we have suggested, with 
ample clothing, which has been thoroughly sterilized and disin- 
fected. If he has recently been engaged in the handling of a 
putrid wound or some infectious or transmissible disease, and 
especially if he has recently been engaged upon a case of retained 



Prevention of Infection 621 

afterbirth or in removing a putrid fetus from another animal, he 
should first, by all rules of surgical practice, have taken a thor- 
ough bath and had a complete change of clothing, in addition to 
having thoroughly and carefully disinfected all those portions of 
his body which have been in any way soiled or contaminated 
during the previous operation. He owes this duty, not only to 
the owner of the animal, but equally to his own reputation as a 
practitioner. 

When called to a case of dystokia, he should prepare an abun- 
dant supply of efficient disinfecting solutions which he can use 
in disinfecting anew his hands and arms immediately before be- 
ginning his operation. 

The thorough cleansing and disinfection of the hands and arms 
serves a double purpose in practice. It protects the patient 
against any infection which the operator may carry upon his 
hands or arms and, when the skin and skin glands of the operator's 
hands and arms are well saturated with a disinfecting solution, 
it affords to him a definite protection against infection from the 
animal. 

This danger of infection to the operator, especially in cases of 
a putrid fetus or afterbirth, constitutes one of the greatest risks 
with which the veterinarian has to contend. There are few vet- 
erinarians who have not, at one or more times, suffered more or 
less seriouslj' from infection from these causes, and it is of funda- 
mental importance that this danger be guarded against as thor- 
oughly as possible. 

Such infection usually occurs, not on the hands, but on the 
arms, where the skin is more delicate and the hair folicles and 
sweat glands offer a better opportunity for the entrance of micro- 
organisms. Apparently those persons who sweat freely are 
most subject to infection in obstetric operations. 

Some depend chiefly upon the lubrication of the hands and 
arms with oil or fat, to which possibly some disinfectant has 
been added, but it has been our constant observation that fats 
and oils are immediately dissolved by the fetal fluids, and conse- 
quently cease to afford any protection almost as soon as the hand 
and arm have been introduced into the genital passages. Such 
anointing of the arms is of little value from the standpoint of 
the prevention of infection of the operator, but has some value as 
a lubricant. Infection of the operator's hands and arms may be 
largely or wholly prevented in several ways. 



622 Veteri?iary Obstetrics 

We may use a variety of disinfectants, and the thorough use 
of any one of them will render a more or less efficient service. 
I/ysol has a marked superiority as a disinfectant in these cases, 
because, in addition to possessing a high bactericidal power, the 
solution is unctuous and renders the hands and arms slippery as 
would oil or fat, and thus favors their introduction into the geni- 
tal passages. Possibly a better protection to the operator may 
be afforded by astringent antiseptics. Corrosive sublimate, with 
its high bactericidal power, possesses astringency to a consider- 
able degree, and tends thereby to close the mouths of the hair 
follicles and glands in a way to prevent the invasion of the dis- 
ease organisms. Permanganate of potash also has a very high 
efficienc3^ and is more astringent than the corrosive sublimate. 
It has still another very estimable quality, in cases of putrid de- 
composition of the fetus, in that it is one of the best, if not the 
best deodorizer which is in common use. After using this 
drug it is necessary to use a warm concentrated solution of oxalic 
acid to decolorize the stain on the skin. If some one of these 
antiseptics is used frequently and freely in this way and, as 
soon as one supply of the solution becomes contaminated, it is 
thrown away and a fresh solution prepared, much will be accom- 
plished toward preventing any infection of the operator's hands 
or arms. 

Preliminary to any measures looking to the prevention of in- 
fection of the hands and arms of the operator by the direct appli- 
cation of antiseptics to these parts, should be the disinfection of 
the patient. Before undertaking the examination or operation, 
the tail, vulva, and all the surrounding parts should be thoroughly 
cleansed and disinfected. If the vaginal canal is soiled, it should 
be thoroughly flushed out with a disinfectant. If the fetus is 
putrid, there should be repeatedly forced into the uterine cavity, 
alongside of the fetus, large volumes of a warm disinfecting fluid, 
preferabh' of l5^sol, because of its unctuous character. Not only 
should the uterine cavity be filled with large volumes of such 
disinfectants prior to the beginning of the operation, but the dis- 
infection should' be repeated frequently throughout the entire 
operation. By such a plan, not only is the operator protected, 
in the largest measure possible, but the patient also is protected 
against serious infection through abrasions which may exist or 
be caused in the course of the operations. 

If the animal is recumbent and cannot be induced to stand, it 



Examination of the Patient 623 

is desirable to spread a clean sheet or cloth, which has been 
dipped in a disinfecting solution, immediately behind the animal 
in a way to cover over any bedding or litter and prevent it from 
being dragged into the genital tract of the mother upon the hands 
or arms of the operator. 

After the removal of the fetus, in all cases of dystokia, it is 
important at once to follow with the removal of the membranes, 
if practical, after which the uterus should again be disinfected 
thoroughly with a large volume of antiseptic solution, providing 
always that we can be sure that the integrity of the uterine walls 
has been preserved and that there are no penetrating wounds 
into the peritoneal cavity. In the latter case we .should simply 
attempt to remove mechanically all the infectious material, so far 
as is in our power, and be very careful to not inject fluids into the 
uterus which will find their way into the peritoneal cavity and 
probably at once cause the collapse and death of the patient. 
If it has been clearly determined that the uterus is wholly intact, 
the injection of large volumes of warm disinfectants into its cav- 
ity produces three important results : disinfects the cavity and 
decreases the danger to the patient later, from infection and its 
consequences ; serves an important purpose by straightening out 
the walls of the uterus and tending to correct any displacements 
of the organ — if one of the horns is somewhat displaced or has 
begun to evaginate or evert, it tends to restore it to its proper 
position ; the presence of the warm solution in the uterus, in suf- 
ficient volume to cause distension, stimulates a quite vigorous 
contraction of the organ — involution — which tends strongly to 
eliminate the uterine cavity and prevent prolapse of the uterus or 
vagina. 

The Examination of the Patient. 

Before proceeding with any operations in cases of d5'stokia, it 
is essential that the practitioner should make a careful examina- 
tion of his patient. First he should determine as well as practi- 
cable her condition, whether she is strong and vigorous or weak 
and debilitated, or he should determine if there is anything in 
her general condition which would suggest some serious or fatal 
lesion, such as internal hemorrhage from a uterine rupture. 
This knowledge can be gained partly by the general appear- 
ance of the patient and partly by examination of the pulse and 
visible mucous membranes. 



624 Veterinary Obstetrics 

It is highly important also that the veterinarian determine 
very early, both from a forensic and a professional standpoint, 
whether empirics or others have meddled with the case prior to 
his arrival and have caused thereby more or less serious injury, 
which, if passed unnoticed, may later lead to serious embarrass- 
ment to him. 

It is exceedingly unfortunate, for example, for a veterinarian 
to be called to attend a case which has previously been meddled 
with by an empiric, to the extent of rupturing the uterus or 
causing some other fatal lesion, and to proceed with the opera- 
tion of delivering the animal without having first discovered that 
the fatal injury exists. Should this error be committed, the vet- 
erinarian is almost inevitably blamed with having caused the in- 
jury himself and might even be held legally responsible for the 
consequences. 

In one case we were called to attend a valuable mare suffering 
from dystokia, in which the head of the fetus was deviated to the 
side and an empiric had attempted to catch the head with a butcher' s 
hook in order to correct the deviation, but failed to do this and 
had ruptured the uterus instead. We were not advised that 
anyone had attempted delivery, and in fact meddling with the 
case was denied. We proceeded to perform embryotomy without 
examining the uterus very carefully except in the posterior re- 
gion. When nearly through with our operation of embryotomy, 
the rupture was discovered owing to the prolapse of the intes- 
tines of the mare through the rent in the uterus. It was only 
under hard pressure that the owner was finally compelled to ad- 
mit that other parties had attempted the delivery before we had 
been called. 

Similar experiences are common in veterinary practice, and 
should always be guarded against as caref ullj' as possible, because 
such oversight is liable at any time to very unfavorably affect 
the professional standing of the veterinarian. 

In such an examination the practitioner should also determine 
the condition of the genital organs in every way, whether the 
passages are fully dilated or are dilatable, whether they are nor- 
mal or obstructed, or if the}' are inflam.ed, swollen or necrotic. 

It is highly important also to learn at once whether or not 
there is any displacement of the uterus, such as torsion. The 
condition of the fetus is also highly important in reference 
to the course to be pursued and the prognosis. It should be de- 



Examination of the Patient 625 

termined as early as possible if the fetus be dead or alive, and, in 
case it is dead, much depends upon whether or not it has under- 
gone decomposition. 

In ruminants an emphysematous or putrid fetus may fre- 
quently be removed with excellent results, since they are very 
resistant to infection from this source, while it is a well known 
clinical fact that it is difficult to save the life of a mare if her 
fetus has become putrid. It is also exceedingly diflScult to save 
the life of a mare if she has been in labor more than 24 hours, 
although much will depend upon the position in which the fetus 
lies, whether it has become impacted in the pelvic canal or not, 
and the amount of interference which the mare has suffered at 
the hands of incompetent persons. 

:■; ^; ^ ^c ^; rf: ^ 

It is highly important that" the veterinarian determine precisely 
the nature of the obstacle which is to be overcome, to which end 
it is essential that he should be able to identify the various por- 
tions of the fetus by the sense of touch, and to determine there- 
by the presentation, position and deviation with which he has 
to deal. While apparently it should be easy for the operator to 
determine the portion of the fetus which he touches, it is not, 
after all, a light task. 

The differentiation between the anterior and posterior limbs 
sometimes offers very great difficulty. Some writers give cer- 
tain rules by which one may differentiate between an anterior and 
a posterior limb, but their rules are not wholly applicable. Some 
suggest that certain joints of the limb bend in a given direction. 
In dystokia, however, a limb may be in such a position that it can 
not possibly be determined in which direction it would bend, be- 
cause it is so firmly impacted that it cannot be bent or moved in 
anj' direction. 

Inside the uterus, with that organ closely investing the fetus, 
the differences, to the touch, between the anterior and posterior 
limbs are not so marked sometimes as the obstetrist would wish. 
If he can readily reach the fetal body, he may quite easily deter- 
mine which leg he is dealing with. He cannot, however, tell 
the fore and hind feet apart until he at least reaches the carpus 
and tarsus. Even then the tarsus may be so extended that it 
presents a very strong resemblance to the carpus, though they 
may generally be differentiated because the os calcis, with the 
40 



626 Veterinary Obstetrics 

tendo- Achilles attached to its summit, is more prominent and 
clear-cut than the pisiform bone of the carpus with its attached 
tendons. If the elbow can be reached and compared with the 
stifle, they are generally quite easily distinguished, and as soon 
as we can reach above these two parts the difficulty of differenti- 
ation usually ceases to exist. 

In examining the limbs for purposes of identification, the in- 
experienced veterinarian must preserve his equanimity and not 
be too hasty in his conclusions, but deliberately search the ex- 
tremities with which he is dealing until they are clearly identi- 
fied upon anatomical grounds. 

' In the event of 3 or 4 limbs being presented simultaneously, 
it is sometimes more difiicult to trace and identif}' each member 
because of their intricate entanglement. The passages are so 
filled, because of the extra number qf limbs, that one can insert 
the arm only with difficulty, and under such severe pres,sure that 
the sense of touch is somewhat dulled. When the feet of two 
fetuses present simultaneously, they are liable to cause very great 
confusion in diagnosis, and one needs be very careful to deter- 
mine if twins exist or not. 

Sometimes twins may offer in the inlet one hind limb of each 
fetus, the head and one or both fore feet of one fetus with one 
or both hind feet of the other twin, or other confusing variations. 
All such possibilities are to be carefully considered. 

In fact, we might state, as a rule in practice, that a foot should 
not be drawn upon to any great extent with a view to extract- 
ing a fetus, unless we have first determined by exploration tiiat 
it belongs to the fetus which we desire to exert traction upon. 
If the veterinarian is at all careless in his diagnosis, he may get 
hold of one limb belonging to one fetus and another limb belong- 
ing to a second fetus, and proceed to draw upon them as belonging 
to one, with embarrassing results. 

It must be constantly remembered also, in the identification of 
the feet of one or more fetuses which are presenting, that a sin- 
gle fetus may be deformed in such a way that both the anterior 
and posterior parts of the body are simultaneously presented, and 
thus we may have offered at the pelvic inlet the head and all four 
feet. This is especially true in the cow, where we meet with two 
forms of monsters which are exceedingly confusing in this respect. 
The most common of these forms is the schistocornms reflexus, in 
which the fetus is virtually turned inside out, so that its viscera 



Exaniinatio7i of the Patient 627 

are lying outside the fetal body, free in the uterine cavity, 
while the skin of the posterior part of the body is turned inside 
out and envelops the anterior portion as a bag, with the hair on 
the inside and the head and all four feet presenting toward the 
pelvis, without regard for any systematic arrangement, in a con- 
fusing tangle. 

A more orderly deformity of the fetus, which we have seen in 
the cow, is the campylorrhachis contortus^ in which there is an 
abrupt lateral curvature of the spine, without the body being 
open. In this we find the fetal head, resting upon the two fore 
limbs, presenting at the pelvic inlet, and with it the two 
hind-feet with the soles of the feet turned upward; or in other 
words, we find the anterior portion of the fetus in an apparently 
normal anterior presentation, dorso-sacral position, with the head 
and anterior feet presenting in the most favorable manner, and 
also an apparently normal posterior presentation, dorso-sacral 
position, with the hind feet fully extended in the pelvis. Such 
a presentation is exceedingly confusing because it constantly 
suggests twins, though when attempts are made to repel one part 
and advance the other it is found to be impossible. On the other 
hand, when one part is rep'felled the other recedes, and when 
one is advanced the other advances likewise. 

In some cases, where there are important teratologic condi- 
tions, it is difficult to determine the part of the body with which 
one is dealing. It is necessary to study carefully the anatomical 
relations of each part. In hydrocephalus, with a large amount 
of fluid in the greatly distended cranial cavity, the part some- 
times reminds one very much of the fluctuating abdomen of the 
fetus, and can be differentiated only by finding and recognizing 
the ears, eyes, mouth, or some other definite part of the fetus. 

So with every other part, the veterinarian must continue his 
search until he is able to fully recognize the anatomical charac- 
ters with which he is dealing. It may be necessary, for this 
purpose, to extend his search for a considerable distance in every 
direction in order to make out fully and safely the character of 
the position with which he has to deal. The special difficulties 
of diagnosis in given cases will be more fully con.sidered under 
their various heads. 

The General Handling of Dystokia. 

A thorough examination, such as we have already outlined, 
should result in a diagnosis of the presentation and position of 



628 Veterinary Obstetrics 

the fetus and its relation to the genital organs and the pelvis, 
should give us a clear conception of the difficulties which are to be 
overcome, and indicate the method by which they may be sur- 
mounted. 

It is also essential, after the examination has been made, that a 
judicious prognosis should be reached, both as related to the 
mother and to the fetus or fetuses. It should be determined whether 
the life of the mother can probably be saved, and by what means, 
and whether, in case she is saved, her condition will be such as 
to render it worth our while either from an economic or a senti- 
mental standpoint. If the life of the mother cannot be saved by 
an operation, it is evidently needless to make a prolonged effort 
in her behalf. If she may be saved, but her condition will ren- 
der her of little or no economic value, or would overcome any 
sentimental reasons for preserving her life, then the situation 
should be made perfectly clear to th$ owner. For example, in 
a case of dystokia in the mare, which has been meddled with by 
an empiric, and in which the fetus has been dead for along period 
of time and has become putrid, and perhaps in addition there is a 
rupture in the uterus which must inevitabh' lead to a fatal termi- 
nation, it is clearly injudicious for the veterinarian to attempt 
delivery, and he should strongly insist upon the destruction of 
the animal. 

On the other hand, so long as there is reasonable hope that 
the animal's life may be saved, it is the duty of the veterinarian 
to do whatever may be in his power to accomplish this purpose. 

The veterinarian, in his prognosis, should refrain with equal 
care from radical optimism and pessimism. The destruction of 
a patient suffering from dj^stokia should not be recommended or 
urged except upon the most unequivocal grounds. It is a com- 
mon observation for one veterinarian to pronounce a case hope- 
less and the dj'stokia insurmountable, and for another veterinarian, 
b}' intelligent work, to save the life and value of the animal. 

Sometimes the veterinarian gives an unfavorable prognosis 
and advises destruction in order to escape from a difficult or re- 
pulsive task. This is very bad polic}', and lowers the standing of 
the veterinarian. If possible to save the patient, the veterinarian 
should proceed to make an earnest attempt to do so. After 
having done his utmost, his responsibility ends. In other in- 
stances, like in severe cases of rupture of the prepubian tendon, 
it is impossible to bring about a recovery of the mother from the 



General Handling of Dystokia 629 

injury, in so far as her general appearance is concerned, but she 
must be forever left with an immense hernia which virtually de- 
stroys her value in any position where appearances have any 
weight. Hence, although the life of the mare may be saved, her 
value is usually destroyed. But she may have a temporary value 
for rai-sing the foal which is to be born at the time, or even a 
permanent value if the owner does not object to the appearances. 

The obstetrist must also reach as reliable a conclusion as pos- 
sible in reference to the life of the fetus, and determine if it is 
possible to save it or not. We have already suggested that the foal 
perishes quickly when expulsive efforts set in, while the calf does 
not, and this and other known facts should be considered in de- 
termining the probability of extracting the fetus in a living con- 
dition, if it is still alive when the veterinarian reaches the patient- 
In the mare, if the obstacles to birth are of such a character that 
much time will inevitably be demanded to overcome them, it is 
quite clear that a living foal is not to be expected, and conse- 
quently, if conditions so indicate, the veterinarian is fully war- 
ranted in proceeding at once with embryotomy. 

Sometimes the obstacles are such that we may be able to save 
the life of either the mother or fetus equally well, but cannot 
save both. In such instances the veterinarian is placed in a 
position where it is necessary to consider which of the animals, 
the mother or the fetus, possesses the greater value, and the life 
of which can be most certainly saved. The decision must largely 
rest with the owner, though the veterinarian needs be in a posi- 
tion to place the question clearly before him. 

Having reached a satisfactory diagnosis and prognosis, the 
veterinarian needs determine upon a definite plan of procedure, 
and this may be either tentative or final. Generally speaking, 
the veterinarian must consider the consequences of his plan upon 
the mother and the fetus, the amount of labor which will devolve 
upon him, and the consequent economic feature to the owner. 

In many cases it is desirable to adopt a tentative plan of pro- 
cedure, with an alternate final operation in case the first should 
fail. It is essential that the tentative plan should possess 
certain definite possibilities, and consequently offer hope of 
a favorable solution. We might illustrate this by compar- 
ing two analogous positions in the foal and calf. In each 
of these, in the anterior presentation and dorso-sacral position, 
the head is frequently deviated laterally. In the calf the neck 



630 Veterinary Obstetrics 

is very short, and the head is usually within reach, so that the de- 
viation may be corrected with more or less facility. With the 
foal this deviation is quite frequently due to a deformity of the 
neck, known as wry-neck, in which case the neck has been 
extremely bent during a great part of its intra- uterine life and the 
head rests far back in the foal's flank, where it is difficult or im- 
possible for the obstetrist to reach it. Even if it can be secured, 
it may still be almost impossible to correct the deviation because 
of the deformity. In case of the calf, the tentative plan of cor- 
recting the deviation almost always succeeds, and should be ap- 
plied. In many instances, in the foal, the correction of the de- 
viation is so improbable that it may be injudicious to attempt it, 
but we should rather proceed at once to embryotomy. Even if 
such a foal be extracted alive, it would still be worthless because of 
its deformed head and neck. Judgment must be used, and a ten- 
tative plan not carried too far, exhausting the strength of both 
obstetrist and patient in an attempt to accomplish something 
which must eventually be abandoned and another plan sub- 
stituted. 

Already we have had occasion to suggest that the obstetrist 
should carefully husband his strength. There is still an abun- 
dance of work for him, and the overcoming of dystokia not in- 
frequently proves a herculean task and leaves him in the end 
quite exhausted from the severe ordeal. We would not, how- 
ever, over-emphasize this strain upon the physical powers of the 
veterinary obstetrist, as some writers have done, and have him 
believe that this work is extraordinarily trying or dangerous. 
We have not found that it offers any markedly greater difficulties 
than other surgical procedures. When the veterinary obstetrist 
promptly attends a case, he usually has time to plan his work de- 
liberately and to carry it out without extraordinary haste. There 
come crises in these operations, as well as in others, where a man 
must act quickly at a given point in order to accomplish his pur- 
pose, but as a general rule there is every reason for deliberation 
and careful planning of every portion of the work. 

A great source of strength and efficiency to the veterinary ob- 
stetrist is ambidextrousness, which can be acquired by any one 
with proper practice. When the operator can use each hand and 
arm with equal facility, his efficiency is more than doubled. It 
is usually the hands and arms, not the body, which really be- 
come fatigued during obstetric operations. 



OBSTETRIC OPERATIONS. 

In overcoming dystokia, a number, of operations may be de- 
manded, which vary greatly in character and which may admit 
of many variations in technic. It is but natural that the obstet- 
rist should be as conservative as possible in the selection and car- 
rying out of a plan for the overcoming of obstacles to delivery, 
He should have in mind the entire list of available obstetric ope- 
rations, and determine which of these he should elect to carry out 
in a given case. In determining upon a plan for operating, he 
should consider first that plan which is the most conservative, 
since if it succeeds it is best from the standpoint of the well-being 
of the mother, of the fetus, of the operator, and of the eco- 
nomic interests of the owner. 

The chief obstetric operations are : 

1. Mutation, or changing the position of the fetus. 

2. Forced extraction. 

3. Embryotomy. 

4. Caesarian section, or gastro- hysterotomy and hysterec- 

tomy. 

I. Mutation. 

In the preceding pages we have indicated that, in order for 
birth to take place normally, it is essential that the fetus should 
present in a longitudinal direction, either anteriorly or posteri- 
orly, and that it is highly important, if not quite necessary, that 
the fetus should be in the dorso-sacral position. In the larger 
domestic animals, it is essential that, in the anterior presentation, 
both fore-feet should be well extended, and the head resting upon 
these with the nose reaching nearly to the fetlock joint. In the 
posterior presentation, the two posterior limbs should be fully 
extended. Any deviation from this attitude in the larger animals 
calls for more or less interference on the part of the obstetrist, 
in order that birth may occur. 

It has been noted that in the smaller domestic animals the at- 
titude of the fetus in its passage through the birth canal differs 
somewhat from the above. In the carnivora, when in the ante- 
rior presentation, the head usually presents alone, with the feet 
doubled back beneath the chest. The position of the fetus or the 
deviation of parts is exceedingly variable, and it is the function 
of the obstetrist to bring each part into the normal presentation 



632 Veterinary Obstetrics 

and position, or otherwise overcome the obstacles to birth. The 
chief operations or manipulations by which it is hoped to correct 
the position or attitude of a fetus are repulsion, rotation, version 
and extension. 

A. Repulsion or retropulsion of the fetus consists of push- 
ing it backward, or away from the pelvis, toward the diaphragm, 
in order that it may be returned into the abdominal cavity, and 
contemporaneously into the uterine cavity, where space is avail- 
able for changing the position of the various extremities or of 
the entire body. It is necessitated by the fact that the pelvic 
canal is so narrow, and so completely filled by the fetus when it has 
once entered, that there is little or no room for carrying out any 
extensive changes in the attitude of the fetus, and consequently 
it must be repelled or pushed away from this narrow channel 
into a more commodious cavity, where ample room may be 
obtained. 

While considering the various obstetric instruments and their 
uses on page 595, we have described the methods for producing 
repulsion. 

B. Rotation. It has already been stated that, in order for a 
fetus to pass readily through the birth canal, it must offer in the 
longitudinal presentation and the dorso-sacral position. When 
presenting otherwise, it is desirable, if not necessary, that the 
fetus be rotated upon its long axis until it is brought into the 
dorso-sacral position, and its expulsion or extraction thus facili- 
tated or rendered possible. 

The rotation of the fetus upon its long axis is naturally most 
practicable when its body is lying within the abdominal cavity, 
because, when it is advanced into the pelvic canal, it is exceedingly 
difficult to bring about such a rotation owing to the limited room. 
In accomplishing rotation it is to be borne in mind that a fetus 
entering the birth canal in any other than the dorso-sacral posi- 
tion is in an unstable attitude and tends to rotate to the proper 
position, except as prevented by the firm impaction of the fetal 
body in the narrow channel. 

The aim of the obstetrist is to aid these natural forces as far 
as possible in accomplishing the object desired. First of all, the 
body of the fetus should be pushed away, if possible, into the ab- 
dominal cavity, while its limbs are retained in the pelvic canal, 
as levers, through which the rotation may be largely accom- 



Obstetric Operations 633 

plished. Preparatory to rotation it is highly advantageous to in- 
ject into the uterus, about the fetus, a weak solution of lysol or 
other emollient liquid, to lubricate the uterine cavity and permit 
the body of the fetus to be more readily revolved. 

Most cases demanding rotation offer in the posterior presenta- 
tion, and usually in the dorso-pubic position. In these, after 
the repulsion of the fetus and lubrication of the parts, the two 
posterior feet should be secured by means of cords, to be held by 
assistants. The operator inserts one hand with the palm up- 
wards and passes it over the brim of the pubis beneath the but- 
tocks of the fetus in such a way that the buttocks rest in the 
palm of his hand. The pubic brim serves as a fulcrum, upon 
which the operator uses his hand and arm as a lever of the first 
class. Lifting upwards against the buttocks of the fetus renders 
its position less stable and tends to cause it to revolve to the right 
or left and approach the dorso-sacral position. The instability 
which has thus been produced may be accentuated by the opera- 
tor exerting his force somewhat obliquely upwards to the right 
or left, instead of pushing directly upward. This tends to rotate 
the body of the fetus in that direction which may seem most 
favorable. 

The assistant in charge of the corded hind feet actively sec- 
onds the efforts of the operator by such means as the obstetrist 
may direct. It has been suggested by some writers that the two 
feet may be tied together and a short lever passed between them, 
upon which the assistant may exert a rotary force upon the fetal 
body in that direction which the operator may direct, thus 
rendering effective the efforts of the veterinarian. In our personal 
experience, we have usually had the assistant grasp one or both 
of the hind limbs, flex the feet at the fetlock until the pastern 
of each foot is at right angles to the metatarsus, and, using the 
pastern as a lever, exert a rotary force upon the limb and 
through it upon the fetal body. We have found this method 
highly efficient. 

Another very effective method, in our experience, has been 
the application of what we may term cross-traction upon the hind 
limbs. A cord is placed upon each limb, and each cord given 
into the hands of separate assistants. The operator places his 
hand beneath the croup of the fetus, over the brim of the pubis 
of the mother, as in the preceding plan. If he wishes to rotate 



634 Veterinary Obstetrics 

the ventral surface of the body of the fetus toward the right of 
the mother, he lifts upward and to the left, upon the buttocks, 
while the assistant having charge of the cord upon the right foot 
stands upon the right side of the patient and draws obliquely 
upward to the right, changing the direction gradually to the 
right and thence downwards. The assistant having charge of 
the cord upon the left foot crosses it behind the right, draws 
gently obliquely backward to the left, and aids the rotation 
by holding the fetus away from the right side of the pelvis. 

In the anterior presentation, the general plan of the operation 
is similar, though it may be rendered far more difficult bj' the 
presence of the head and neck. It may even be necessary that 
the head be amputated before the rotation can be effected. Aside 
•from this the plan should be carried out essentially the same, ex- 
cept that the operator's hand acts upon the withers of the fetus, 
instead of upon the buttocks, as in the preceding case. 

C. Version. Since it is essential that a fetus present longi- 
tudinally in order to be expelled, it follows that, when it presents 
more or less transversely, such an attitude needs be changed to 
the longitudinal presentation before the fetus can enter the pelvic 
canal. In other words, we must change the presentation of the 
fetus by bringing its long axis into a line parallel with the spinal 
axis of the mother. Empirics occasionalh' state that they have 
accomplished version of the fetus when it has presented longitu- 
dinally and have changed a posterior presentation into an anteri- 
or one. This assertion has been to some extent copied by some 
veterinary writers. It must be very plain to any intelligent vet- 
erinary obstetrist of experience that such an operation is impos- 
sible, under normal conditions, and could only be carried out in 
cases where the uterine cavity is very large and the fetus very 
small, in which case there is evidently no good reason whatever 
for carrying it out. Version is confined in obstetric practice 
to the changing of a transverse into a longitudinal presentation. 

Version may be of two classes — anterior and posterior. The 
operator usually prefers to convert a transverse into a posterior 
presentation, because he then needs deal with but two extremi- 
ties, the hind limbs ; whereas, were he to convert into an ante- 
rior presentation, he would need bring the head and both anterior 
limbs into the passage. 



Obstetiic Operations 635 

When the fetus presents transversely, with either the dorsal or 
the ventral surface toward the pelvic inlet, its version must be 
accomplished by causing one extremity of the fetus to advance 
and the other to recede. This is caused by exerting traction on one 
extremity while repelling the other. When the fetus presents 
transversely it usually does so by the ventral surface, with the 
head and all feet more or less in reach, and several or all of them 
requiring attention upon the part of the obstetrist. Assuming 
that the obstetrist desires to convert a ventral transverse into a 
posterior presentation, he first identifies the two posterior limbs 
and attaches cords to these. In the foal he should usually next 
amputate the two anterior limbs (see Subcutaneous Amputation 
of the Anterior Limbs) in order to render the operation easier 
for the operator and safer for the mare. The amputation is not 
usually advisable in the cow, and is not always absolutely neces- 
sary in the mare. 

When the question of amputation of the forelimbs has been 
decided, and carried out or not as circumstances may dictate, an 
assistant exerts traction upon the two posterior limbs, while the 
operator applies or directs repulsion upon the sternum or other 
portion of the head end and pushes it away as far as possible into 
the uterine cavity, while the posterior end of the fetus is being 
advanced by the traction upon its hind limbs. While the version 
is being accomplished the operator should see that the necessary 
rotation of the fetus on its long axis is also occurring. The 
required rotation is best attained, in such cases, by what we 
have described on page 633 as cross traction. When the version 
has become essentially completed and the rotation accomplished, 
the extraction of the fetus is continued by means of traction up- 
on the posterior limbs. 

Should the operator desire to convert a ventral transverse into 
an anterior presentation, which we never advise, he would secure 
and apply traction to the two fore limbs and the head, and at the 
same time repel the posterior limbs as far forward as possible. 

In the dorsal transverse presentation, the version needs be exe- 
cuted in a manner similar to that designated for the ventral pre- 
sentation. Here extremities are not available for the exertion 
of force. If it is desired to convert into a posterior presentation, 
which we prefer, the head end of the fetus is to be repelled b}^ 
force applied obliquely forward and toward the head end of the 



636 Veterinary Obstetrics 

fetus, until the tail may be reached and traction applied to it, or a 
hook implanted in the anus or about the buttocks, so that traction 
may be applied to the tail end, causing it to advance until the 
hind legs may be secured and the traction applied to them. 
When the posterior limbs have been secured and the feet have been 
brought into the passage, it yet remains to rotate the fetus and 
convert the dorso-ilial into the dorso-sacral position, after which 
the rules for delivery in posterior presentation, dorso-sacral 
position, apply. 

D. Extension and Adjustments of the Extremities. In 
dealing with the attitude of the fetus during parturition, we have 
described the normal position of the extremities and have noted 
that, when they become materially deviated, they produce more 
or less serious obstacles to the expulsion of the fetus. The de- 
viations with which the obstetrist must deal are those of the 
head, neck and limbs. 

The correction of these deviations must be carried out anterior 
to the pelvic cavity, within the abdomen. It is consequently 
essential, in most cases, that the fetus be repelled in order to 
bring about these corrections. It should be constantly remem- 
bered that, in a large proportion of cases, repulsion of the body of 
the fetus, and those extremities which are presenting normally, 
has a constant tendency to bring about a correction of the devi- 
ation. 

If the head is deviated to the right or the left, upward or down- 
ward, repulsion of the fetal body tends constantly to cause the 
head and neck to become extended. The reflexed head comes 
in contact with the uterine walls, which resist its retreat while 
the body is being repelled, and the head then tends to come for- 
ward into its normal attitude. The same is more or less true 
with most of the deviations of the extremities, which are con- 
stantly aggravated as the fetus advances toward the vulva, and 
tend as constantly to be ameliorated or even overcome when the 
fetus is repelled into the uterine cavity. 

In addition to the two foregoing factors, the securing of room 
and the natural tendency for these parts to become extended in 
their proper position during repulsion, the veterinarian must in- 
telligentl}' apply his knowledge of mechanics and anatomy to 
his task. If the head is reflected to the left side of the fetus 
along the right side of the mother, it is very evident that, if 



Obstetric Operations 637 

the patient is lying upon her right side, the weight of the 
fetus upon its bent neck will offer a serious mechanical obstacle 
to the correction of the deviation. In such a case the re- 
cumbent patient should be turned to her left side. Similar 
directions apply also to deviations of the limbs, and should con- 
stantly be borne in mind in all such work. 

Another point of mechanical advantage which should be con- 
stantly applied is that, if we wish to extend a flexed extremity, 
we can at least double the efficiency of our efforts by the simul- 
taneous application of traction upon the distal end of the flexed 




Fig. 107. Schematic Ii,i,ustration of the Extension of a Fore 
Limb flexed at the Carpus. { Franck. ) 

extremity and repulsion upon its proximal end or upon the fetal 
body. For example, in the deviation of the head to the left, if we 
can apply traction to the head by means of a hook in the orbit, 
mouth or nose, or by a cord attached to the inferior maxilla, as 
shown in Fig. 108, and described on page 581, while the body of 
the fetus is being repelled by force applied to the sternum or base 
of the neck, the efficiency of our efforts is very greatly increased. 
The simultaneous application of these two forces should be the 
constant aim of the veterinarian. The traction may be applied 
with hooks or cords ; the repulsion by the operator's hand, or by 
a repeller in the hands of an assistant. 

In extending a flexed limb, the same general mechanical rules 
are to be applied. Take for example a fetus presenting anteriorly 
in the dorso-sacral position, an anterior limb flexed at the carpus, 
Fig. 107. When the fetus has been repelled, with or without 
decapitation, and sufficient room for operating obtained, the re- 
tained foot is corded at the pastern, or as near to that point as is 
possible, by one of the two methods described on page 579, and 
the cord is entrusted to an assistant. 



638 



Veterinary Obstetrics 



If impossible at first to attach the cord about the pastern, it 
should be made fast as low down on the metacarpus as possible. 
While traction is applied upon this cord by an assistant, the 
operator may pass a second cord beyond the first, and, as the foot 
is being brought nearer by traction upon the first cord, the noose 
of the second may be pushed over the fetlock and engaged upon 



^ 


^B^r^-.n.L r^jv^jeaH 


|BB8^^ 


V,i 


j 

1 

i 

i 
i 

i 



Fig. io8. Method of Securing the Lower Jaw by means 
OF A Looped Cord. 
the pastern. It is to be emphasized that in correcting a devia- 
tion of a limb, whether anterior or posterior, the ultimate aim is 
to get the noose upon the pastern. Until that can be accom- 
plished, the correction of the deviation is uncertain. 



Obstetric Operations 639 

While the fetus is being repelled, the assistant draws upon the 
cord and advances the foot. The carpus, by this process, and 
with the aid of the operator, passes into the lumbar region, 
directed obliquely outwards and upwards into the upper portion 
of the flank in order to afford the greatest possible amount of 
room. The carpus (or tarsus) must not, for this purpose, abut 
against the unyielding lumbar vertebrse or lateral processes, but 
must be pushed outward against the yielding flank, and room 
thereby afforded for the necessary extension of the foot. At the 
proper time the operator inserts his hand, palm upwards, be- 
tween the pubic brim and the foot of the fetus; grasping the toe 
in the palm of his hand, the assistant, by the operator's direction, 
applies traction upon the cord, and the foot glides over the pubic 
brim, to become extended in the pelvic canal. 

Should the anterior limb be completely retained, instead of 
merely flexed at the carpus, the procedure is similar. The foot 
is now wholly out of reach, and the forearm can be reached only 
with difficulty, or not at all until repulsion has occurred. When 
sufficiently repelled, the forearm is grasped with the hand and 
corded while the repulsion is continued, and the carpus is 
gradually drawn up until it comes against the pubic brim, when 
its further correction is carried out in the same manner as above 
suggested. 

Similar rules apply to the corrections of the deviations of the 
posterior limbs; that is, the fetus must be repelled from the pelvic 
inlet, and that part of the limb which can be reached must be 
corded and brought up. This in itself acts as a repellant to the 
fetal body, and finally the tarsus is pushed obliquely outwards 
and upwards into the upper flank region, the pastern corded, and 
the toe, enclosed in the hollow of the operator's hand, is guided 
over the pubic brim and extended in the pelvic canal. 

These changes in position constantly require a careful applica- 
tion of mechanical principles, and are to be carried out with 
caution. The work should be done as gently as possible, in order 
to avoid arousing violent expulsive efforts. When they do occur, 
and constitute too great an obstacle, they should be overcome by 
such means as those suggested on page 619. While generally 
we would bring about these corrections without haste, when we 
reach a critical point it is frequently essential that they should be 
accomplished very promptly. Thus, when the carpus or tarsus 



640 Veterinary Obstetrics 

has been pushed into the upper flank region and the toe or fet- 
lock is impacted against the brim of the pubis, it is important 
that the operation be completed promptly, both because an}' un- 
necessary delay may lead to a return of the foot to its former 
position and because violent expulsive efforts of the mare may 
cause serious injuries to the uterus or other parts. 

II. Forced Extraction. 

By forced extraction we understand the withdrawal of the 
fetus from the mother, through the genital canal, by the applica- 
tion of traction, without changing the position of the fetus or any 
of its extremities which may be deviated, or reducing its size. 
It is applied in those cases where the abnormal size or position of 
the fetus, or of one of its extremities, is such that the obstetrist 
believes that it is better to draw the fetus away by force than to 
correct the position, or deviation, or to perform embryotomy or 
Caesarian section. 

The reasons which may prompt the obstetrist to resort to 
forced extraction may be quite varied. It may be that forced 
extraction will offer the best or only opportunity for saving the 
life of the fetus. In the foal, for instance, forced extraction, in 
rare cases, might save its life, whereas the delay which might be 
essential to the correction of the position would lead to its death. 

From the standpoint of .saving the life of the mother, it may 
sometimes be safer to resort to forced extraction than to submit 
her to a tedious operation, not unaccompanied by dangers, in 
correcting the position of the fetus, in embr5'otoniy or in Caesar- 
ian section. As a general rule, in the larger animals embryot- 
omy, properly carried out, is less dangerous to the mother than 
forced extraction. It is only in very rare cases that this rule is 
reversed. In the smaller animals embryotomy is usually im- 
practical, and our choice of procedure frequently rests between 
forced extraction and Caesarian section. 

From the standpoint of the operator, forced extraction is easier 
and consumes much less time, but the results are generally un- 
satisfactory. The higher the knowledge and skill of the veter- 
inary obstetrist, the less frequently does he resort to forced ex- 
traction of the fetus. 

The empiric habitually resorts to forced extraction in a very 
brutal manner, and with great losses to the owners of patients. 



Forced Extraction 641 

We have frequently known empirics, who were not competent to 
perform embryotomy when a foal presented anteriorly with the 
two anterior limbs in the birth canal and the head completely 
deviated to the side, to apply a sufficient amount of brute force to 
tear the fetus away in a most inhuman manner. Sometimes they 
hitch a horse or horses to the foal, and tear it away very roughly. 
One empiric in our territory resorted habitually to tying a strong 
rope to the two anterior feet of the foal and fixing the other end 
of it to a tree or a strong post, and then, by means of a whip or 
other punishment, forcing the mare to pull away her own fetus 
in a most brutal manner. So far as I was able to follow his 
operations, they invariably resulted in the death of both the mare 
and fetus. 

Other veterinary obstetrists advise forcible extraction in various 
positions, though with more foresight and care. Some report 
good results, but so far as we have learned never so good as 
though embryotomy had been properly performed. 

Forced extraction .should not be employed in most cases of 
improper presentation or position of the fetus. It cannot succeed 
in any transverse presentation, but only in those which are 
longitudinal. 

Forced extraction should be limited, in its application, to those 
cases where the fetus is comparatively large and in the normal 
position, and in which the withdrawal of the fetus by force will, 
in the judgment of the obstetrist, prove better for the interests 
of the owner, as affecting the life of the mother, the fetus, or both, 
than would other means of delivery ; and to those cases of un- 
natural position or deviation of the extremities in which it would 
be better and safer for the mother or fetus, or both, to force the 
fetus through the birth canal without its position having been 
corrected. 

Personally, we have limited forced extraction to those cases 
where a large fetus, or a fetus of normal size enlarged because of 
emphysema, presents in a normal position, and in our experience 
such a course has been fully warranted. We have already dealt 
with the technic of forced extraction when dealing with instru- 
ments of traction on page 586. 

III. Embryotomy. 

Embryotomy is the diminution of the size of the fetus by 
means of the removal of some of its parts, in a manner to overcome 
41 



642 Veterinary Obstetrics 

the obstacles to its birth. Necessarily embryotomy involves the 
sacrifice of the life of the fetus, if it is still living, and the object 
of the operation becomes limited to the preservation of the life 
of the mother. It is a comparatively common operation in the 
larger animals, but is virtually inapplicable in the smaller ones. 

Embryotomy possesses certain dangers, such as injuries to the 
maternal organs, from a slip or misdirection of an instrument or 
from the projection of a severed fetal bone which may wound or 
penetrate the uterus or other parts. Not infrequently it involves 
a long and tedious operation, which may greatly exhaust the 
.strength of the patient. 

For the operator, embryotomy frequently means a protracted 
and disagreeable operation, with danger of wounds from instru- 
ments, injuries from the mother, or infection in case the fetus is 
putrid. Nevertheless embryotomy is one of the most common 
and valuable obstetric operations, and requires, for its proper ap- 
plication, thorough study, supplemented by extensive and prac- 
tical experience. 

The performance of embryotomy may involve any portion of 
the fetal body, and presents the greatest possible variations 
according to the presentation and position. The veterinarian 
must have a thoroughly practical knowledge of the anatomy of 
the fetus and the resistance of tissues and parts. Embryotomy 
may be necessary or advisable in every presentation and position 
which the fetus may assume, whether it be normal or abnormal. 
We shall deal with the question as related to the removal or 
destruction of certain portions of the fetal body, and leave the 
application of these to be considered under the various forms of 
dystokia. 

We shall consider the technic of the various embryotomy 
operations, as they may be demanded in the four fundamental 
presentations, in the order we have already described on page 
537- 

A. The Anterior Presentation. 

a. Amputation ofthe Head. Decapitation. In the anterior 
presentation, with one or both fore limbs retained and the fetal 
head engaged in the pelvic canal or protruding from the vulva, 
repulsion of the fetus is generally necessary in order to correct 
the deviation of the limb. In many cases the repulsion of the 



Embryotomy 643 

head is inexpedient or impossible, and the amputation of the head 
is made advisable or necessary in order that the fetal body may be 
repelled and the deviated extremity brought into position. 

Technic. Attach a cord to the inferior maxilla, as shown in 
Fig. 108, or around the neck of the fetus, or fix a blunt hook in 
the orbit, and have one or more assistants draw the head out as 
far as possible. 

Make a circular incision through the integument, encircling 
the head at a convenient point, and separate the skin backward, 
by forcing the hand between it and the bones or by using the 
chisel or spatula or dissecting it away with a scalpel, continuing 
the separation over the occiput to the atloid region. Make a 
transverse incision below, across the trachea and esophagus and 
surrounding muscles, and above through theligamentum nuchae. 
Grasp the head firmly with both hands, flex it upon the neck, 
and twist it forcibly on its long axis, rupturing the articular lig- 
aments and the remaining soft tissues, detaching the head at the 
occipito-atloid articulation. The removal of the head greatly 
diminishes the bulk of the fetus ; the remnant may now be re- 
pelled, the deviated parts brought into the desired position, or 
other operations performed. 

b. Cephalotomy. When the fetal head has not advanced 
far into the pelvic canal or cannot enter the pelvic inlet on ac- 
count of the comparatively large size of the head, when the pelvis 
is narrowed by a tumor or callus, or when the fetal head is grossly 
enlarged because of hydrocephalus, it may become necessary 
to diminish the size of the head, though it is not in a position to 
be amputated. 

Tecluiic. In these ca.ses the head is usually so firmly en- 
gaged in the canal that no further fixation is necessary. After 
thoroughly cleansing and disinfecting the parts, inject a copious 
amount of tepid lysol solution into the vagina. Carry the ob- 
stetric chisel into the passage, carefully guarded in the hand, 
and place it accurately upon that part of the head of the fetus 
where it is desired to begin the operation, generally on the me- 
dian line of the nose with the blade of the chisel standing parallel 
to the septum nasi of the fetus. Holding the blade of the chisel 
firmly against the part, with the hand in such a position as to 
effectively guard the instrument from slipping aside and wound- 



644 Veterinary Obstetrics 

ing the maternal organs, steady and direct the handle with the 
other hand and have an assistant drive the chisel, by means of 
blows of proper vigor with a mallet, into the bones of the face 
and head. 

Do not drive the chisel deeper than the length of the blade, 
without first stopping and forcibly revolving the instrument upon 
its long axis and breaking the fetal bones apart. The partially 
detached pieces of bone may be torn away with the fingers of one 
hand, and the chisel used to complete the separation of the frag- 
ment. Repeat the use of the chisel here and there upon the 
head, as often as may be necessary in order to bring about the 
required diminution, taking care, at all times, not to wound the 
maternal parts and to conserve as far as practicable the fetal skin 
of the face and head, in order that it may protect the maternal 
parts from the jagged fetal bones during the remainder of the 
operation. The removal of the partially detached pieces of bone 
may in many cases be greatly facilitated by looping a cord over 
them and having an assistant apply traction sufficient to pull 
them away, while the operator guards the maternal organs by 
holding the piece of bone, during its detachment and extraction, 
in the palm of his hand. 

In hydrocephalus the diminution of the head alone usually 
removes the sole obstacle to delivery. The same is true occa- 
sionally of beginning emphysema, where as yet only the head is 
greatly involved. In other cases, the destruction of the head 
and face does not wholly relieve the dystokia. It may be neces- 
sary to continue the diminution by decreasing the volume of the 
neck and body. The cervical vertebrae may be divided with the 
chisel on their median line, the muscular and ligamentous at- 
tachments broken down or cut with the chisel, and the bone frag- 
ments secured in a rope noose and drawn away, covered by the 
hand during their withdrawal. Later the fetal body may be 
further diminished by subcutaneous amputation of the fore limbs 
at the shoulder, evisceration, destruction of the pelvic girdle, or 
other means to be later described. 

c. Amputation of the Head and Neck. In the anterior presentation, 
when the head is completely deviated and it is impossible or impracticable 
to return it to its normal position, some veterinary obstetrists advise that 
the neck be severed and the head with the distal portion of the neck with- 
drawn, after which the body of the fetus is extracted. 



Embryotomy. 645 

Technic. Some obstetrists advise the use of Persson's chain-saw, Fig. 103 
or the chain sector of Masch. More recentlj' there has come into high 
repute, in some portions of continental Europe, the embryotom of Pflanz, 
Fig. 99. These instruments are passed around the curved neck, and act 
chiefly from the distal side of the member. 

The most effective instrument of the group is apparently the Pflanz 
embryotom. However, any one of them will accomplish the purpose, once 
they have been passed around the neck, but this offers considerable difficulty. 
The chain-saw and sector have the disadvantage, as compared with the 
Pflanz embryotom, that they must be drawn backward and forward in 
order to saw their way- through the tissues, and constantly tend to wound 
the soft parts of the genital canal by coming in contact with them. This may 
be largely or wholly obviated by passing a sheath of leather or other 
material over the chain, and working it through this. 

When the Pflanz embryotom has been applied to the part, danger of injury 
becomes virtually excluded, and the work of section is rapidly and easily 
carried out. 

In the application of these instruments, some operators claim that there 
is an advantage in first passing a cord around the neck, with the bent porte- 
cord or the bent cord-sound. Once the cord has been passed around the 
neck and is attached to the chain-saw or sector, the latter may be easily 
drawn into position. 

With the Pflanz instrument, a smooth chain is first used to pass around 
the neck, which is free from any danger of injury to the soft parts of the 
mother and is comparatively easy to handle. 

Other operators divide the neck by means of cutting instruments acting 
upon the front or proximal side, and use for this purpose the finger-knife, 
bistoury, or chisel, but with these instruments the process is a comparatively 
tedious one, as it is difficult to cut through every portion of the tissues. 
With the knife it is impracticable to sever the cervical column, since the 
vertebrae cannot be disarticulated, and it becomes necessary to use some 
more powerful instrument for severing the bony column. This may best be 
done with the chisel. 

Each plan has its advantages and disadvantages. The latter may be pre- 
ferable or necessary where it is extremely difficult or even impossible to 
apply the chain to the neck. 

In our personal experience we have not found it desirable to resort to the 
amputation of the neck in cases of deviation of the head, but have constantly 
preferred to amputate one anterior limb subcutaneously, followed by 
evisceration, which operations we shall describe below, after which the fetal 
remnant may be extracted without difficulty, with the head turned back, 
or the head may be readily brought into position , as the operator may prefer. 

d. Subcutaneous Amputation of the Anterior Limbs. 

Amputation of the anterior limbs is very frequently called for 
in obstetric practice, especially in the mare, chiefly in cases of 
the ventral transverse presentation, with all four feet oflFering 



646 Veterinary Obstetrics 

and the head retained ; in cases of wryneck in the foal in the 
anterior presentation, dorso-sacral position, when it is impracti- 
cable to correct the deviation of the head ; or in any case in the 
mare or cow where deviation of the head cannot be corrected or 
is not so readily performed as is the amputation of the limb. 

Technic. The larger herbivorous animals are devoid of a 
clavicle, and the anterior limb is attached to the thorax by means 
of the skin and muscles only, and is therefore comparatively easily 
amputated. Attach a cord to the pastern of the limb, the 
shoulder of which lies most exposed or is most readily reached, 
and have one or two assistants exert traction upon it, and 
draw it out as far as possible with safety to the mother. Insert 
one hand, armed with the hooked embryotomy knife, well guarded 
in the palm of the hand and resting against the limb of the fetus 
up to the top of the scapula or as nearly thereto as can be 
reached ; press the knife into the skin and subcutaneous tissues 
and, drawing the hand downward along the leg, slit the skin and 
subcutaneous tissues freely and deeply from the top of the 
scapula down to the pastern. Lay aside the knife and force the 
fingers between the skin and subjacent tissues of the limb and, 
while the assistant maintains gentle traction, separate the skin 
from the parts beneath by forcing the hand or the ball of the 
thumb through the loose connective tissue until the upper region 
of the scapula is reached. 

The separation of the skin from the subjacent parts may re- 
quire at certain points, like the region of the olecranon or carpus, 
the aid of the chisel or knife to divide firm bands of connective 
tissue. The separation of the skin from the subjacent parts re- 
moves the chief resistance to the tearing of the limb away from 
the body. Until the skin has been separated from the subjacent 
tissues over the leg and shoulder, it should be kept intact at the 
pastern, so that, when traction is applied, the skin as well as the 
leg is rendered tense and the skinning is greatly favored. When 
the skinning of the leg and shoulder is completed, the skin is to 
be divided at the foot by girdling the pastern. The detached 
skin will be of no further importance, and may be ignored. If 
required, it may be grasped and corded with a small cord. 

Next in power of resistance are the pectoral muscles. These 
may be torn asunder by first being separated into small bundles 
and then torn through with the fingers, between the sternum 



Embryotomy 647 

and the limb. The process may be aided by incision with a knife 
or with the chisel. 

When the foregoing are well divided, the remaining impedi- 
ments to tearing the shoulder away consist essentially of the 
trapezius and rhomboideus muscles at the top, the latissimus 
dorsi behind, and the great serratus and angularis scapula, all of 
which come into action only when the shoulder is nearly severed, 
and then offer no serious resistance. Consequently it is only 
necessary to separate the skin from the limb and divide the pecto- 
ral muscles in order to readily draw the limb away by traction. 

When the skin has been detached and the pectoral muscles di- 
vided, two or three assistants exert traction upon the limb, while 
the operator places his hand against the sternum and pushes in 
the opposite direction. The impact upon the maternal organs 
from the traction may be reduced to any desired degree, by ap- 
plying a repelling force to the sternum of the fetus. 

The impact upon the maternal organs equals the difference be- 
tween the traction applied upon the cord and the repulsion applied 
to the fetal sternum. Should the hand of the operator not 
suffice, the repeller should be applied, carefully guarded by the 
hand of the operator, the necessary force being supplied by one 
or more assistants. 

Should the traction fail to bring the limb away promptly, the 
operator should attempt to extend the division of the muscles 
attaching the limb to the thorax, while moderate traction upon 
the limb is continued. 

Further diminution of-the size of the fetus may now be had by 
the removal of the other limb in the same way. This is especially 
desirable in the transverse presentation with all four limbs in 
the passage. The size of the trunk may also be further reduced 
by evisceration, as described on page 658. 

When a foal presents anteriorly in the dorso-sacral position, 
with lateral deviation of the head which it is impracticable to 
correct, the subcutaneous removal of one anterior limb, followed 
by evisceration, so reduces the volume of the fetus that the rem- 
nant can be easily withdrawn without correcting the deviation 
of the head. It also renders the fetal remnant so flaccid, and 
so far increases the room by the reduction of size, that the devia- 
tion is easily corrected. 



648 Veterinary Obstetrics 

In the ventral presentation, the subcutaneous removal of both 
anterior limbs greatly facilitates version, and reduces to a mini- 
mum the dangers of injuries to the uterus during version, owing 
to a foot being caught in its walls. 

e. Amputation at the Humero-Radial Articulation. Am- 
putation at this point is rarely desirable, but may at times 
be necessary in the mare in order to remove an anterior limb 
when it is impossible, on account of the position, to reach the 
shoulder. 

Techyiic. Attach a cord to the pastern, as in the preceding, 
and have an assistant render the leg tense by exerting moderate 
traction. Introduce the hand, armed with the embrj^otomy 
knife, carefully' concealed in the palm, and girdle the skin around 
the articulation. Passing above the head of the olecranon on the 
posterior side, divide the attachment of the anconean group of 
muscles by a cut directed forward. Then divide transversely, as 
far as possible, the muscles and ligaments passing over the artic- 
ulation. Rotate the limb forcibly on its long axis while strong 
traction is maintained, and rupture the remaining ligaments until 
the limb is completely detached and comes away. 

In cases of limited room, it may sometimes be easier to detach 
the skin of the limb from the pastern up to the articulation, as 
in the operation for the subcutaneous amputation of the limb at 
the shoulder, as described above. By this plan the skin is sepa- 
rated up to the olecranon, the muscles divided transversely, and 
the operation otherwise carried out as in the preceding para- 
graph. 

f. Detruncation in the Anterior Presentation. When 
a fetus in the anterior presentation has one or both pos- 
terior limbs deviated forward beneath its body, and the feet en- 
gaged against or in the pelvis, it may be necessary or advisable 
in the mare, and possibly rarely in the cow, that the trunk of the 
fetus be divided in order to bring about delivery without serious 
or fatal injury to the mother. 

Technic. Secure the two hind feet by means of cords. Ap- 
ply cords to the two anterior limbs and head, and have one or 
two assistants draw the anterior part of the fetus as far out as is 
practicable and safe. Then girdle the fetal body immediately 
against the maternal vulva, by making an incision through the 



Embryotomy 649 

skin and skin muscle. It is frequently best at this point to re- 
move one shoulder subcutaneously, as described on page 645, and 
follow with evisceration, as described on page 658, in order to 
give greater operative room and increased mobility of the fetus' 

Insinuate the hand between the skin and the deeper structures, 
and forcibly separate the skin from the fetal body backward until 
the last rib is passed. Force the finger tips through the abdom- 
inal wall behind the last rib and, passing along the entire poste- 
rior border of each last rib, separate the abdominal walls from 
the ribs and sternum. After the abdominal muscles have been 
detached and the fetus has been eviscerated, rotate the thorax 
upon its long axis. This will cause a division of the vertebral 
column near the dorso-lumbar articulation, and the anterior por- 
tion of the fetus will fall away. 

Secure the two posterior feet with cords, unless this has already 
been done ; spread the detached skin, which has been pushed 
back from the thorax, carefully over the stump of the lumbar 
vertebrae ; pu.sh the remnant of the fetal trunk into the uterus 
with the hand, while an attendant draws upon the cords attached 
to the hind feet and advances them along the genital passages, 
thus causing a posterior presentation. This may result in a 
dorso-pubic position, w"hich should be converted to dorso-sacral, 
when the extraction of the fetus can be readily brought about. 

g. Destruction of the Pelvic Girdle in the Anterior 
Presentation. Somewhat rarely, perhaps most frequently in 
the cow, the pelves of the mother and fetus become interlocked 
and the antero-external angles of the fetal ilia, I' Fig. log, become 
locked with the shafts of the maternal ilia I, at C, in such a man- 
ner that any safe degree of traction fails to overcome it. 

Technic. Remove one anterior limb subcutaneously, page 
645, and eviscerate, page 658, through an opening made by the 
removal of two or three of the exposed ribs. Introduce the 
chisel through this opening, carry it back with the hand and 
place it against the shaft of the fetal ilium I'. Have an assistant 
drive the chisel through the iliac shaft, from before to behind, 
and, when the chisel blade is well buried in the ilium, revolve the 
instrument forcibly upon its long axis and thoroughly divide the 
pelvic girdle by separating the cut ends of the bone. Then 
withdraw the chisel and replace it against the pubic brim, either 



650 



Veterinary Obstetrics 



at the symphysis pubis or opposite the foramen ovale, and drive 
it through the pubis and ischium at either of these points. Again 




revolve the chisel forcibly upon its long axis, and thoroughly 
break the bones apart. The coxo- femoral articulation is thus 
detached and isolated, so that the entire limb may drop back- 



Etnbryotomy. 651 

ward beyond its fellow, and the remnant of the severed ilium I' can 
drop inward or move in any direction. The entire pelvis thus 
loses its rigidity and undergoes diminution in size, so that it can 
readily be withdrawn. 

B. Embryotomy in the Posterior Presentation. 

a. Amputation of the Posterior Limbs at the Tarsus. 
When a fetus, especially a foal, presents posteriorly, with one 
or both posterior limbs retained at the tarsus, it- may be difficult 
or impossible to repel the fetus and extend the feet. The diffi- 
culty of the correction of such a deviation is intensified by re- 
cumbency, the comparatively large size of the fetus, and by fetal 
emphysema. In such cases it is frequentl}' easier for the ob- 
stetrist and safer for the mother to amputate the limb or limbs 
at the tarsus. 

Technic. Pass a cord around the leg above the tarsus, as indi- 
cated in Fig. no, and have an assistant hold the leg steady by 
gentle traction. Introduce the chisel, carefully guarded in the 
palm of the hand, and place it against the lower part of the tar- 
sus, as shown between T and T. The chisel should be placed 
as nearly perpendicular to the long axis of the metatarsus as pos- 
sible. The proper direction of the chisel may at times be greatly 
favored by placing the cord upon the metatarsus instead of the 
tibia, thus forcing the tarsus toward the sacrum of the mother 
and tending to throw the metatarsus straight across the pelvic 
cavity. 

The chisel should at all times be held in the palm of the hand, 
with the dorsal surface of the hand against the vaginal or uterine 
walls, and the instrument carefully guarded and guided during 
the entire operation. The amputation should preferably be 
through the lower section of the tarsus, but maybe made through 
the head of the metatarsus. The chisel should not be driven 
entirely through the hock without removal, as it may become 
caught and clamped between the divided bones ; instead, drive it 
first for only a few inches along the lateral side of the tarsus, being 
sure that the skin at that point is included in the cut along with 
the bone. Then loosen the chisel, and force the divided bones 
apart by rotating the instrument upon its long axis, after which 
it may be driven somewhat deeper into the tarsus, until the foot 
is completely severed. 



652 



Veterinary Obstetrics 



Withdraw the severed metatarsus, remove any dangerous frag- 
ments of bone remaining on the stump, and see that the latter is 
safely secured by a cord passing around the leg above the os cal- 




cis. Repeat the operation on the other hock in a similar manner. 

Apply traction to the two limbs, and effect a posterior delivery. 

The technic for amputating at the tarsus varies with different 



Einbryotomy . 653 

obstetrists, and those who prefer to use the chain-saw, sector, 
Pflanz instrument, or other form of embryotom, would ampu- 
tate with such an instrument. Any one of them is efficient, 
providing always that the hock is easily reached and lies, or can 
be placed, in such a position that the instrument can be applied. 
It is possible also, though very difficult, to amputate the hock 
with a scalpel. 

Instead of amputating the hock, in cases where it is offering 
a serious obstacle to parturition, some operators sever the tendo- 
Achilles, by which means they permit the metatarsus to fold 
against the inferior surface of the tibia and the toe of the foot to 
become somewhat extended, so that it will offer less obstruction. 

b. Intra-Pelvic Amputation of the Posterior Limbs in 
the Breech Presentation. This operation is designed for the 
overcoming of dystokia due to a posterior presentation with the 
hind limbs completely retained in the uterus, the so-called breech 
presentation, when the deviation cannot be readily corrected. 

Technic. Introduce one hand, armed with the embryotomy 
knife, scalpel or chisel, through the maternal passages, until the 
perineum of the fetus is reached, and make a free incision 
through that part, including the anus in the male fetus and the 
anus and vulva in the female, enlarging the incision sufficiently 
to admit the operator's hand into the fetal pelvis. 

Locate the great sciatic ligament of the fetal pelvis and, in- 
serting the knife into it just behind the shaft of the ilium, divide 
the former backward to the perineum, thus enlarging the pelvic 
cavity and giving ample operating room. If the pelvis of the 
fetus is too small to admit the hand of the operator at all before 
severing the sciatic ligament, this may be accomplished by cau- 
tiously cutting from behind forward with Colin' s scalpel or with 
the chisel. 

When this has been severed and sufficient operating room at- 
tained, carry the chisel in the hand and place it against the shaft 
of the ilium, as shown between I' and I', as nearly perpendicular 
to the long axis of the iliac shaft as possible. Keeping the hand 
in touch with the chisel blade, have an assistant drive it through 
the bone until it and its periosteum are completely severed. 
Forcibly rotate the chisel upon its long axis, in order to complete 
the division of the bone and attached soft parts. Disengage the 
chisel, and then place it against the symphysis pubis or 



654 



Veterinary Obstetrics 



against the ischium opposite the foramen ovale, and drive 
it through the ischium and pubis at one of these points. Again 
revolve the chisel upon its long axis and, using it as a 




lever, separate the isolated portion of the pelvis as com- 
pletely as practicable from the surrounding tissues. With the 
fingers, aided by the chisel if necessary, detach the muscles from 



Embryotomy. 655- 

the isolated segment of the pelvic girdle for a short distance 
from each severed end. Attach a strong looped cord about the de- 
tached pelvic segment, and tighten the noose. Have one or more 
assistants apply traction as indicated in Fig. iii B. The chief 
obstacle to the withdrawal of the limb is the great gluteus muscle, 
which should be sought for, identified, and torn through with the 
fingers at a distance of 5 or 6 cm. from its attachment to the 
great trochanter of the femur. This is best done while steady, 
firm traction is being applied to the limb by an assistant, thus 
tensing the muscle. 

Other important points of resistance are the attachments, pos- 
teriorly, of the skin, vulva and anus to the ischium through the 
medium of aponeurosis ; and anteriorly, chiefly on the median 
line, of the prebubic tendon. These should be divided with the 
knife or chisel. Vigorous traction may now be applied by means 
of the cord, while the operator guards the advancing end of the 
detached piece of pelvis with the palm of the hand, in order to 
prevent injury to the maternal organs. 

Sometimes the isolated piece of the pelvis tears loose from the 
femur and comes away alone. In such a case, the cord is to be 
applied over the head and trochanter of the femur, and traction 
again exerted, drawing the limb away in a reversed position. 
As it advances, the skin is turned backward or everted until the 
region of the hock is reached, where the integument does not so 
readily separate and only requires to be divided to allow the 
limb to come away. 

During the removal of the limb, the operator is to constantly 
note the progress by manual exploration, and sever by tearing or 
cutting any tendons or muscles which offer special obstruction 
to the operation. During the tearing away of the limb, the 
operator largely or wholly counteracts the impact of the traction 
upon the maternal organs, by applying repulsion to other portions 
of the fetal pelvis, either with his hand or with the aid of a 
repeller in the hands of an assistant. 

Repeat the operation upon the opposite limb in the same 
manner, except that but one incision need be made through the 
bone, that is, through the shaft of the ilium. During the entire 
work the operation is carried out subcutaneously, or rather intra- 
fetally, and, if properly performed, the maternal parts are amply 
guarded against injury. 



656 



Veterinary Obstetrics 



The size of the fetal trunk may be further reduced, if desired, 
by evisceration, as described on page 658. The remnant of the 




P SP 



fetus may then be extracted, by traction upon a cord looped 
about the lumbar region of its spinal column. 

After evisceration has been accomplished, should the fetal rem- 



Evibryotoniy 657 

nant still seem too large, because of emphysema or for other 
reasons, to be safely drawn through the pelvic canal, further 
diminution in volume should be accomplished. The chisel may 
be carried into the fetal cavity and placed against the last rib, 
close alongside the spinal column. Light blows upon the chisel 
by an assistant, the cutting end constantly accompanied by the 
operator's hand, readily severs each rib successively. The oper- 
ation can be applied on each side of the spinal column, so that 
all ribs are divided. 

The ribs may also be severed by means of the long-handled 
sphere-pointed cutting hook, Fig. 106 h. The instrument is 
introduced into the fetal body- cavity and hooked over the first 
anterior rib, or the most anterior rib within reach, and the ribs 
are cut one after another as the instrument is drawn backward. 
The sphere upon the point obviates the danger of the instrument 
penetrating the fetal skin and wounding the maternal organs. 

If neither of these instruments is at hand, the obstetrist 
may destroy the ribs by manual force. The tips of one or more 
fingers may be forced through the intercostal muscles between 
the last two ribs, the intercostals then torn asunder from the base 
or spinal end down to the sternal cartilages, and the rib grasped 
and broken. Rib after rib may be treated thus until all are 
broken. This is a tedious operation, and there is constant danger 
to the operator of wounds from the sharp broken rib ends. 

The division of the ribs is of very great importance. It allows 
complete collapse and obliteration of the fetal body cavity, and 
renders the fetal remnant very flaccid and pliable. More im- 
portant perhaps, it permits the escape of the imprisoned gases of 
emphysema under the pressure of the labor pains. 

When the ribs have been destroyed, further diminution may be 
accomplished bj^ securing a scapula from inside the chest, cording 
it and drawing the leg out through the cavity of the fetal body. 

The amputation of the hind limbs may be accomplished by 
other means. The above plan offers the greatest decrease in 
the volume of the fetus ; the manipulations are carried on ex- 
clusively within the fetal body, insuring the greatest possible 
safety to the patient, and when completed afford ready means 
for evisceration. The operation is neither tedious nor difficult, 
when compared with obstetric operations generally. 
42 



658 Veterinary Obstetrics 

Some operators advise the use of Persson's chain-saw, or the Pflanz ma- 
chine, and amputate the posterior limbs as close to the hip-joint as possible. 
The application of these instruments is not always easy. In either case a 
cord or chain is passed around the limb as close as possible to the hip-joint, 
and the limb is then severed in the manner described on pages 604 
and 644, for the neck in the anterior presentation. 

Other operators would cut through the soft tissues with a scalpel and 
attempt to disarticulate the femur from the pelvis. It must be extremely 
difficult to disarticulate such a joint as this while the fetus is confined in the 
uterus and the limb is virtually immovable. 

c. Evisceration. The evisceration of the fetus is frequently 
desirable in obstetric practice, and has a variety of uses. It de- 
creases the volume of the fetal trunk greatly, and permits its more 
ready passage through the genital canal. For example, in the 
anterior presentation, with lateral deviation of the head, it ren- 
ders the fetal trunk flaccid, through the removal of the viscera 
supporting the body walls, and permits the body remnant to be 
bent or moved more readily for the correction of any deviations ; 
it permits freedom of intra-fetal operations directed against other 
parts, as for detruncation, page 648, or for the destruction of the 
pelvic girdle, page 649. When a putrefying fetus becomes enor- 
mously enlarged as a result of emphysema, evisceration removes 
the gases collected in the viscera and body cavity, and permits 
the escape, under pressure in the birth canal, of much of the gas 
imprisoned within the body walls. 

Tech?iic. Evisceration may be employed in either the anterior 
or the posterior presentation, possibly in extremely rare cases in 
transverse presentations. 

I. In the anterior presentation, unless the fetus is far advanced 
through the vulva, evisceration is best performed by the removal 
of one or more of the anterior ribs. The ribs are generally best 
reached by the removal of the shoulder, as already described un- 
der subcutaneous amputation of the anterior limbs, on page 645. 
When the ribs have been laid bare in the manner described, 
the operator can thrust the finger tips through the muscles in the 
first intercostal space, and enlarge the opening thus made by tear- 
ing through the muscles, upwards to the spinal column and down- 
wards to the sternum ; then, grasping the rib near its middle, 
he can fracture it by means of a sudden and vigorous pull. The 
fractured ends may then be grasped, and pulled, broken or 
twisted off. 



Embryotomy 659 

The chisel may be brought into use, if required, in order to 
divide the rib, the hand of the operator constantly guiding and 
guarding the chisel blade. The operation is then to be repeated, 
if required, upon the second and third ribs, until an opening into 
the chest is secured, ample in size for the introduction of the ope- 
rator's hand. 

Force one hand through the opening, and tear the mediastium 
from the thoracic walls, above and below. Then grasp either the 
trachea at its bifurcation, or the heart, and tear away the lungs 
and heart, as nearly as possible in one mass. The heart, which 
constitutes the greatest bulk of the thoracic viscera, is best 
grasped in the palm of the hand, with the fingers engaging the 
aorta and pulmonary arteries. 

When the thoracic viscera have been withdrawn, thrust the 
fingers through the diaphragm, locate the liver, isolate the area 
of the diaphragm to which it is attached, and, engaging both 
with the fingers, remove the two together. 

The liver, in a normal fetus, constitutes the chief intra-abdom- 
inal mass, and occupies more space than all the other organs com- 
bined. After the liver has been removed, the intestinal tube, 
with its contents, may be withdrawn without difficulty, as its 
attachments are feeble. The kidneys may also be removed. 

Evisceration of a fetus in the posterior presentation is prefer- 
ably performed through the pelvis, generally in connection with 
intra-pelvic amputation of the posterior limbs, page 653. It may 
be performed without destruction of the pelvic girdle, by making 
an incision through the perineal region and then severing the 
sacro-sciatic ligament as directed for that operation. 

When free entrance has been gained into the abdominal cav- 
ity, introduce the hand and withdraw the alimentary tube; then 
rupture the diaphragm about the liver and tear away the latter 
organ in the same manner as in the anterior presentation. The 
liver is so friable that it cannot well be removed by grasping the 
organ itself, but comes away entire, with the central part of the 
diaphragm. 

Remove the heart and lungs as directed in the anterior presen- 
tation. 

The efiiciency of the evisceration in decreasing the volume and 
rigidity of the fetal body may be furthered by the division of the 
fetal ribs as noted on page 656. 



66o Veterinary Obstetrics 

Embryotomy under Special Conditions. 

In the foregoing pages we have described embryotomy as it 
may be carried out in dystokia, with the fetus presenting under 
conditions which are more or less subject to classification. These 
directions constitute a general outline, the principles of which 
are more or less applicable in all cases. There occur, however, 
many quite atypical cases to which these general principles must 
be adapted. 

In the various forms of monstrosities, some plan must be 
evolved by which the monster may be sufficiently reduced in size 
to permit of its removal. Double monsters may be divided as 
nearly as possible, or a portion of each body may be removed, 
including evisceration, so that the remnants of the more or less 
double body may be removed together. 

Sometimes other persons have performed partial embryotomy, 
in a way to greatly embarrass the veterinarian. A lirnb has been 
amputated, at such a place that it becomes a positive menace to 
the patient and interferes with, rather than aids in, its delivery. 
Such, for example, is the amputation of an anterior limb at the 
carpus, when the foal is presenting anteriorly or in the trans- 
verse presentation. In such cases the stump of the limb must 
not be pushed back into the uterine cavity, but must be ampu- 
tated higher up, until at least the fore-arm has been removed. 
We meet with similar mutilations, when the fetus presents pos- 
teriorly and some portion which has protruded beyond the vulva 
has been cut away. We have also met with cases in the anterior 
presentation, with the two hind feet projecting forward and en- 
gaged in the pelvis, in which detruncation had been performed 
through the thorax, and jagged bones left, which seriously 
abraded the soft tissues of the mother. It is absolutely neces- 
sary in such a case that the spinal column be shortened by the 
removal of all the dorsal vertebrae and ribs, in order that ver- 
sion may be accomplished and the remnant converted into the 
posterior presentation. It is also essential that the spinal column 
be shortened in order that a flap of the skin and soft tissues may 
be acquired, which will cover the spinal stump and protect the 
uterus and vagina from injury. 

Early in our obstetric career we were called to attend a cow 
which was suffering from dystokia. The presentation had been 



Exercises in Mutations and Embryotomy 66i 

anterior, and apparently normal, but the calf was somewhat large 
and it was necessary to apply traction. A local practitioner 
hitched a horse to the calf, and succeeded in advancing it until 
the fetal and maternal ilia became interlocked. The fetus was 
then cut in two in the dorso-lumbar region, and the posterior 
portion remained in the uterus. With our inexperience, we failed 
to accomplish delivery. 

Various courses might have been successfully pursued. It 
would not have been difficult to have reached into the fetal pelvis 
and engaged it with a blunt hook fixed over the posterior border 
of an iliac shaft. Holding the fetal remnant securely by means 
of the hook or, if preferred, by a cord pa.ssing around the iliac 
shaft, we could place the chisel against the other iliac shaft and 
divide it. Next we could place the chisel opposite the pelvic 
symphysis or the foramen ovale, and again divide the pelvis on 
the median side of the hip joint. We could then loop a cord 
about the isolated segment of the pelvis and, exerting traction 
thereon, remove it, with the hind limb. The remnant would 
then be easily extracted, since the size of the croup would have 
been reduced one-half. 

Complications of the greatest variety may thus arise, and are 
to be met by judicious planning and having the necessary instru- 
ments and appliances at hand for carrying out the work. 

Exercises in the Mutations of the Fetus and in 
Embryotomy. 

The veterinarian who attends a case of dystokia, without having 
first learned by personal experience the mechanism by which 
dystokia is to be overcome, always labors under a serious handi- 
cap. Every veterinarian, before entering upon an obstetric 
practice, should make himself personally familiar with the various 
operations which he may be called upon to perform in the over- 
coming of dystokia. Each of these operations may be planned 
and carried out without great difficulty, and in a manner which 
will give to the veterinarian valuable training, which will prove 
a great help to him in the actual work. 

Various plans are proposed and carried out with a view to 
teaching these operations in an efficient manner. 



662 Veterinary Obstetrics 

The author has had prepared a special skeleton of the cow, 
which has been strongly mounted and securely fixed, so that any 
desired force may be used upon it without danger to the appar- 
atus. Inside the skeletal cavity we have placed a leather sac, in 
imitation of the uterus. New-born calves are procured and 
killed, and the body placed in the artificial uterus in any position 
which may be desired, and the student is asked to correct the 
vicious position or deviation of an extremity, or to perform em- 
bryotomy by a definite plan. In such a case, the work closely 
simulates that encountered in actual practice. The fetus is out 
of sight, and the leather sac may be so adjusted that any desired 
degree of pressure upon the fetus may be commanded. 

The operation must be carried out through the pelvis, and the 
height of the pelvis from the floor is essentially the same as en- 
countered in actual practice in the standing animal. 

Any veterinarian who has not enjoyed the privilege of such 
opportunities in college, or who has not satisfactorily availed 
himself of such opportunities, need not be debarred from the 
benefits of such work. Numerous devices have been described 
and used, many of which are easily and cheaply constructed, and 
readily available to any practitioner. One can take an ordinary 
stout box, of sufficient dimensions to contain the new-born fetus, 
and may make an opening at one end, about the size of the pelvic 
canal. He may then procure, from time to time, new-born 
calves and, placing them in the box, proceed to practice the 
various changes in position or different forms of embryotomy, as 
described. If he desires to approach more nearly to the normal 
conditions, he may use the pelvis of a cow or mare, through which 
to do his work, and beyond it secure the fetus in a box or bag. 
Such apparatus may be placed upon a strong table, or otherwise, 
secured, at a height convenient for the work. Such exercises in 
obstetric surgery are of so great importance that any inexperi- 
enced veterinarian who has to do with dystokia can not properly 
afford to neglect them, because they give to him an experience 
which renders his actual work far more efficient and satisfactory. 
They decrease greatly the strain of his work in actual practice, 
and increase enormously his success as a practitioner. 



IV. CAESARIAN SECTION OR GASTRO-HYSTEROTOMY. 

Caesarian section is the removal of a fetus or fetuses from the 
uterus by means of an incision made through the abdominal 
walls. 

It has its use as a last resort in an attempt to save the life of 
the fetus, the mother, or both, when other forms of delivery are 
impossible or impracticable. 

It is one of the oldest operations in history and has been per- 
formed since the earliest times, both in human and veterinary 
obstetrics. In earlier times it was performed chiefly with a view 
to saving the life of the fetus, and in many cases that of the 
mother was deliberately sacrificed in order to accomplish this 
end. Since the advent of antiseptic surgery, added to the use 
of anaesthetics, the operation has attained a wider application and 
tends frequently to conserve the life of both mother and fetus. 

Quite naturally the operation is most readily carried out and 
is most successful iu the smaller domestic animals, both on ac- 
count of their size and because of their comparative immunity to 
septic infection. In the sow, bitch and cat it frequently occurs 
that both parent and offspring survive if the operation is per- 
formed at the proper time and under strict aseptic precautions. 

It is usually comparatively easj' to extract a living calf from 
the cow, but the mother, under present plans of operating, 
generally succumbs. 

The operation may be successfully performed in the mare, in 
so far as extracting a living foal is concerned, but we have no 
records where the life of a mare has been thus saved. Neces- 
sarily the foal must be extracted very early in case of difficult 
labor, or it perishes because of the detachment of its placenta. 

The chief indications for the performance of hysterotomy in 
the larger animals are : imminent death of the mother, where 
there is hope of saving the life of the fetus ; displacements of 
the gravid uterus, such as irreducible torsion or hernia ; and 
extra-uterine gestation. 

In the sow, bitch and cat, should the pelvis be abnormally 
narrow or a fetus become lodged anterior to the pelvis, whether 
from over-size, mal-presentation or emphysema, embryotomy is 
impossible, owing to the smallness of the pelvic canal; mutations 
for the correction of deviations are well-nigh impossible ; and forced 



664 Veteri7iary Obstetrics 

extraction is frequently dangerous or impossible. Thus the veter- 
inary obstetrist is forced to choose between hysterotomj^ and the 
destruction of the patient. 

TecJmic. When a pregnant animal meets with a sudden and fatal 
accident, is in death throes, or her death is imminent, Caesarian 
section may be roughly performed \>y quicklj' making a free incision 
through the abdomen at the most convenient point, exposing the 
uterus, incising its walls, and promptly liberating the fetus. 
When such emergency does not exist and the operation may be 
more deliberateh'- planned and performed, the technic may be 
varied according to the individual case, the species of animal or 
preferences of the obstetrist. Some operators prefer to make 
the laparotomy upon the median line in the linea alba; others 
prefer to operate in the flank. In the smaller animals, it seems 
to be largely a question of choice on the part of the individual 
operator, though evidently there are advantages and disadvan- 
tages in each plan. In the larger animals, like the mare and 
cow, the operation through the linea alba is impracticable under 
present conditions, so far as the preservation of the life of the 
mother is concerned, because the immense weight of the ab- 
dominal viscera prevents the surgeon, with his present appliances, 
from closing the abdominal incision in such a manner as to sup- 
port the viscera and prevent their protrusion. 

In all animals the flank operation is evidently safer in reference 
to prolapse of the abdominal organs as a result of the breaking, or 
tearing out of the sutures. After the operation the flank wound 
may be kept cleaner, since it does not come into so constant and 
immediate contact with the ground or floor when the animal is 
lying down. In the bitch and sow the flank incision has a fur- 
ther advantage over that through the linea alba. In these ani- 
mals the double row of mammte leaves the median line in a deep 
furrow, which renders suturing difiicult. 

One advantage of the linea alba incision is the possibilit}' of 
affording drainage to an infected uterine cavity, when such is 
not available through the vagina because of some serious dis- 
placement of the organ, such as irriducible torsion or transverse 
rupture through the cervix. In a pet animal, the resultant scar 
may be less objectionable in the linea alba. 

The securing of the animal for the operation must correspond 
with the plan and the intended position of the laparotom}'. 



Ccesarian Section 665 

Harms states that the operation on the cow may be performed 
upon the animal in the standing position, but it would seem to 
us that such a plan would offer very great difficulties. With 
most, if not all animals, it is essential that they be cast, or se- 
cured and placed upon the operating table in lateral recumbency, 
for the flank incision, or in the dorsal position in case the linea 
alba is selected. 

From a humane as well as an operative standpoint, anaesthesia 
or narcosis should be induced. Keller (Zeitschrift fur Tierme- 
dizin, B. 11, S. 122) recommends for the bitch the subcutaneous 
injection of muriate of morphine in doses not exceeding 0.06 g., 
and later, if marked pain and struggling ensue, the inhalation of 
a small amount of ether. De Bruin (B. T. W., January 3, 1907) 
considers chloroform or other anaesthesia highly dangerous in the 
sow, and has had unfortunate results therefrom, so that he 
recommends local anaesthesia, consisting of cocaine muriate 
0.3—0. 5 g. in 10 cc. of distilled water, with the addition of 5 
drops of i-iooo solution of adrenalin chloride. Other plans for 
inducing local anaesthesia of the abdominal walls may be used, 
and when the abdominal cavity is open the anaesthesia may be 
extended to the uterus itself. 

Chloroform anaesthesia in the cow and sheep is somewhat 
dangerous, because of their great tendency to regurgitate food 
from the rumen and then inhale it into the bronchi. If chloro- 
form anaesthesia is produced in the cow, it might be well to ad- 
minister it through a trachea tube in order to guard against food 
inhalation. We may also resort to local anesthesia in the cow, 
remembering constantly that the principal pain in the operation 
consists of the incision through the skin, after which as a general 
rule there is little evidence of intense pain. Complete anaesthesia 
is essential in the mare, if we propose to attempt to save her 
life by the operation. 

In securing an animal for the operation, she should always be 
extended at full length, the hind legs drawn backward and the 
anterior limbs forward, so that they will be completely out of 
the way. In small animals this extension of the limbs may be 
maintained with the aid of assistants, but in the larger animals it 
is essential that the patient be stretched by means of ropes at- 
tached to the hind and fore limbs respectively, the other ends of 
which are securely fixed to posts or other secure objects. 



666 Veterinary Obstetrics 

If we wish to preserve the life of the mother, we should be 
careful to select a place for operating which is clean and free 
from dust. If the animal is placed upon a bed of straw or 
other material, the bedding should be carefuUj^ moistened with 
an antiseptic and all necessary means taken to prevent any stirring 
up of dust by the struggles of the animal. 

The operating field should be carefully cleaned and disin- 
fected. The hair should be removed by shaving over an ample 
area, which should then be disinfected by cleansing with soap and 
hot water with a stiff brush, followed by a thorough washing 
with alcohol or ether to dissolve the fat, after which the part 
should be thoroughly washed with i-iooo corrosive sublimate 
solution or other reliable disinfectants. 

In addition to these precautions, Keller suggests that at the 
point of incision the area should be saturated with tincture of 
iodine in order to complete the disinfection of this region. Prior 
to the application of the tincture of iodine, all liquids should be 
wiped away with antiseptic gauze. 

After thorough disinfection, the neighboring portions of the 
body of the animal should be covered over with cheese-cloth, 
towels or other suitable fabric, which has been sterilized or dis- 
infected so as to prevent dust and hair getting into the wound 
from the animal's body. The sterile or antiseptic cover also 
affords a safe resting place for any protruding abdominal viscera. 
Immediately over the location where the wound is to be made, 
there should be placed an ample piece of sterilized gauze, in 
which an opening is made of the same dimensions as that in the 
abdominal wall. 

The incision is then to be made into the abdominal cavity. 
Generalh^one scalpel should be used for making the skin incision, 
laid aside, and a second scalpel used to continue the incision into 
and through the deeper parts. In the flank the incision should 
begin at about the level of, or slightly below, the external angle 
of the ilium, midway between it and the last rib, and extend 
downward in an approximately perpendicular direction. 

After the skin incision has been made, we may continue it 
directly through the muscles; or in the flank operation we may 
separate the muscle fibers in their longitudinal direction, either 
with the blade or the handle of the scalpel, and not cut across 
the muscle fibers at all. The latter plan of incision would involve 



Casarian Section 667 

a different direction of the opening for each layer of the abdomi- 
nal wall. ' That through the external oblique muscle would be 
obliquely downward and backward, while that of the internal 
oblique would be downward and forward, and the two openings 
would consequently cross each other like an X. 

The peritoneum may be incised with the scalpel, by placing 
an index finger against it and then passing the scalpel along the 
finger until it reaches the membrane, when a very slight thrust 
will force it through. This should be done carefully in order to 
avoid wounding the viscera, and as soon as the scalpel has pene- 
trated the peritoneal cavity, as is indicated by the disappearance 
of resistance, the instrument should be promptly withdrawn. 
The incision can then be enlarged by means of a probe-pointed 
bistoury guided by the finger, or it may be readily torn by the 
fingers. 

The X-formed incision closes automatically, without sutures 
in its deeper parts, and prevents any protrusion of the vis- 
cera. It is more tedious than a direct incision into the peri- 
toneal cavity, and is not so convenient for the operator. The 
size of the wound must necessarily depend upon that of the 
species, and should be no larger than necessary to permit the 
ready withdrawal of the fetus, enclosed within the uterus. 

If the laparotomj' is performed upon the median line, the in- 
cision is made direct, and should begin slightly anterior to the 
pubis, and extend forward a sufficient distance to provide an 
ample opening for the withdrawal of the gravid uterus. 

Having made the incision into the peritoneal cavity, the 
operator passes his hand around the gravid uterus, draws it out 
and lays it carefully upon the sterilized gauze surrounding the 
wound. An incision is then made into the uterus at the desired 
point, generally upon the convex surface opposite the attach- 
ment of the broad ligaments, and in a longitudinal direction. 
If the incision is made near the broad ligaments, it causes more 
hemorrhage, because the blood vessels at this point are more 
numerous and larger. 

Should the suggestion of Harms be followed and the opera- 
tion on the cow be undertaken in the standing position, the in- 
cision in the right? flank is made merely large enough to permit 
the extraction of the calf through it. The uterus is then pressed 
against the abdominal opening, the organ incised, and the fetus 



668 Veteri?iary Obstetrics 

extracted, care being exercised to prevent liquids from falling 
into the peritoneal cavity. 

In multiparous animals it is usually desirable to extract all the 
fetuses through a single uterine incision, and for this purpose it 
is more convenient to make the opening in one cornu, near the 
bifurcation, so that the fetuses from the other horn may be 
readily pressed around through the uterine body to the incision 
which has been made. In some cases, where the fetuses are 
emphysematous and dry, they adhere so firmly to the uterine 
walls that they cannot be moved any great distance without 
serious injury to the organ, and consequently it may be neces- 
sary to make two or more incisions. 

When the incision into the uterus has been made, the fetus, or 
in multiparous animals, that fetus which is nearest to the in- 
cision, is pressed out through the wound by compressing the 
uterus, or the hand may be passed into the uterine cavity and 
the fetus grasped in its membranes and drawn out. In the 
smaller animals, with several fetuses, the others in the same horn 
are pressed toward the opening one after another, or the operator 
reaches his hand into the organ and removes the fetuses one by 
one. When the incised horn has been emptied, he proceeds to 
empty the opposite horn by pressing the fetuses into the body of 
the uterus and then turning them toward the incision. 

When making the incision into the uterus, care should be 
taken not to incise the fetal membranes if it is possible to detach 
them and press the fetus out completely invested in all its 
membranes. This may be done in the sow, bitch and cat. In 
the cow we cannot accomplish this, and consequently it is 
necessary to incise the fetal membranes before the fetus is re- 
moved from the uterus. The longitudinal incision in the uterus 
should be ample to permit the fetus to pass from it without 
great force, lest the incision become extended, probably in a 
transverse direction, by the tearing of the muscular walls, pro- 
ducing a very diffictilt wound to suture. 

If the fetuses are living, they should be freed from their mem- 
branes as soon as extracted, and an assistant should be ready to 
take care of them. If the fetuses are dead and the fetal mem- 
branes decomposed, it may be advisable to carefully mop out the 
uterine cavity with antiseptics and then to remove all liquid as 
far as possible by means of sterilized gauze. 



CcBsarian Section 669 

The wound in the uterus is then to be closed by means of 
Lembert's or other intestinal sutures of silk. 

Before suturing the uterus, all parts except that in which the 
incision has been made should be returned into the abdominal 
cavity. After the uterine wound has been closed by a series of 
interrupted sutures, the remainder of the organ should be allowed 
to drop back into the peritoneal cavity. 

The abdominal incision should be closed by interrupted sutures. 
If the laparotomy has been performed through the linea alba, it 
is desirable to suture, separately, the peritoneum, the muscles and 
the skin. The peritoneal wound may be closed with continuous 
or interrupted catgut sutures which have been immersed in tinc- 
ture of iodine. The sutures for the muscles and skin should be 
of strong silk, thoroughly sterilized or rendered antiseptic. After 
the skin has been sutured, Keller suggests that all the external 
sutures be saturated with tincture of iodine, to guard against 
suture'infection. 

The animal should then be placed in a comfortable room to re- 
cover from the anaesthesia, and allowed to rest quietly. No food 
whatever, and only very small quantities of water, should be 
allowed for 24 to 48 hours after the operation, but later, if the 
animal shows an appetite, it may have a small allowance of suit- 
able liquid food, later a restricted allowance of succulent or soft 
food, and finally in the course of 8 or 10 days may be put upon a 
regular diet. 

Hysterectomy. Under certain conditions of dystokia which 
cannot be relieved by other means, where the fetus or fetuses 
have undergone putrid decomposition and the uterus is in such 
a state of infection or disease that, according to the judgment of 
the veterinarian, recovery of the organ cannot be reasonably an- 
ticipated, it may be deemed best to amputate the entire organ. 
Such an operation totally destroys the breeding value of the ani- 
mal, and its sole use is the saving of the life of the mother. The 
operation has been limited to the smaller animals like the sow, 
bitch and cat, in those cases where decomposition of the fetus 
or fetuses and infection of the uterus are such as to bar success- 
ful hysterotomy. 

The confinement of the patient, disinfection of the operative 
area, anaesthesia or narcosis and other preparations, along with 
the abdominal incision, are the same as for hysterotomy and the 



670 Veterinary Obstetrics 

uterus is to be lifted out of the abdominal cavity in the same 
manner. After the organ has been exposed, the utero-ovarian 
arteries and all visible arteries in the broad ligaments should be 
securely ligated, and a firm ligature of silk placed around the 
cervix or vagina. The entire uterus, horns, and ovaries should 
then be excised, and the vaginal stump securely detained out- 
side the wound. 

In order to prevent the escape of the putrid contents of the 
uterus in the neighborhood of the wound, it is best to apply a 
double ligature to the cervix or vagina and sever the organ' be- 
tween the two. The vaginal stump should be thoroughly 
disinfected, by drying it first with sterile gauze and then 
thoroughly cauterizing the mucous membranes with the thermo- 
cautery or nitrate of silver. Tincture of iodine thoroughly 
applied to the stump, while it is held outside the wound until the 
alcohol has evaporated, may also suffiice. The stump of the 
vagina is then to be allowed to return into the abdominal cavity. 
If infection of the peritoneal cavity is feared, it may be irrigated 
with normal salt solution in the hope of mechanically cleansing it. 

Sometimes partial hysterectomy is preferable to the preceding. 
In irreducible torsion of the uterus or transverse rupture of the 
uterus from torsion the uterine cavity may not be safely 
closed as in hysterotomy, nor completely amputated because of 
adhesions. A portion of the organ may then be excised and the 
margins of the stump securely fixed to the margins of the ab- 
dominal incision, thus affording exterior drainage for the sup- 
purating uterine cavity. 

Prognosis. The prognosis of hysterotomy and hysterectomy 
is generally unfavorable, though it is gradually becoming more 
successful in veterinary practice, as veterinarians become better 
acquainted with anaesthesia and asepsis. It is most favorable 
in small domestic animals, in which incidentally there is less 
susceptibility to infection, although perhaps the main considera- 
tion is that of the size of the animal and the practicability of 
proper control of the wound after the operation. Keller re- 
cords the operation of hysterotomy in 10 bitches, with recovery 
of 8 of the mothers, or 80 %. In 8 out of these 10 cases, some or 
all of the fetuses were saved. In the other cases the fetuses were 
dead at the time when the operation was undertaken. 



CcBsarian Section 67 1 

De Bruin records 23 hysterotomies iu the sow, with 1 1 re- 
coveries and 12 deaths, or a loss of 60%, but he accepted all 
cases of dystokia which were offered and which it seemed impos- 
sible to deliver in any other way. Among these were several 
sows which were already comatose and virtually dying when 
presented. He concludes that, when the fetuses have become 
emphysematous, the sow has a high temperature accompanied 
by loss of appetite with no milk in the teats, or is in a comatose 
condition, the operation will most probably be followed by 
death. He submits also that, according to the statistics of the 
cases which he publishes, the results are very favorable if the 
patient has not been manipulated prior to the operation, and 
there is no extensive necrosis of the vaginal walls as a result of 
the forcible extraction of one or more fetuses or attempts at that 
operation by laymen. De Bruin regards the operation as highly 
successful in those cases where no manipulation of the genital 
tract has been made, except by the veterinarian, under proper 
precautions, for purposes of diagnosis, and where labor has not 
continued for more than 24 hours. 

Kasselman (D. T. W. , 1899) operated on 25 sows, with recov- 
eries in 19 cases. In his statistics, all those cases in which the 
fetuses were putrid perished. 

So far as we can determine by the available literature, the op- 
eration is somewhat less favorable in the cat. In our clinic, in 
two cases, one of the cats died, but the fetuses were saved in each 
instance. 

Hysterotomy in the sheep and goat has not been largely prac- 
ticed, so far as indicated by our literature, although a few suc- 
cessful operations have been chronicled. 

It has been clearly shown in the cow that, if the fetus is alive, 
Caesarian section is highly favorable for preserving the life of the 
calf. Its attachments to the maternal placenta are of such a char- 
acter that it is very easy to perform hysterotomy and preserve 
the life of the fetus if it is in good, vigorous condition at the 
beginning of the operation. 

Little is known regarding the percentage of recoveries of the 
cow, although there are isolated records where recovery has oc- 
curred. Franck places the loss in cows at 65%. This appears 
to be a very great loss, and suggests that perhaps many of the 
cases were in a very serious condition before the operation was 



672 Veterinary Obstetrics 

undertaken, and were virtually hopeless. The cow with- 
stands laparotomy splendidly, as is well shown by the 
operation of spaying through the flank. She is quite resist- 
ant to lesions of the uterine walls, and so it would appear that 
she could withstand hysterotomy with comparative safety if we 
had, to begin with, an aseptic uterus and uterine contents. The 
difficulty with the operation is largely due to the fact that the 
fetus and its membranes have undergone putrid decomposition 
and that the uterine cavity has become infected before the ope- 
ration is attempted. Under such conditions, success can scarcely 
be hoped for in a reasonable number of cases. In many instances 
it is quite impracticable for the veterinarian to determine early 
the advisability of the operation. 

Iviving foals have been repeatedly removed from the mare by 
Caesarian section, but we have been unable to find a record where 
the life of the mare has been preserved. We do not believe that 
this total want of success is necessary. We know full well that, 
under modern surgical methods, we can perform laparotomy in 
the horse without serious danger. Since this is true, there is no 
essential reason why hysterotomy should not succeed in some 
cases. We grant that it never can be made as successful as in 
the cow. There are, however, some cases, especially those of 
transverse or bi-cornual development of the fetus, in which no 
successful delivery has yet been recorded, where the prompt 
performance of hysterotomy might offer some hope for the 
life of the mother. The foal is already dead when the veterin- 
arian is called, but it and the uterus need not yet be infected to 
any great degree. 



MATERNAL DYSTOKIA. 

Maternal dystokia may be dependent upon a great variety of 
causes. Any general disease or disorder which may unfavorably 
affect the maternal system may render the pregnant animal in- 
competent to expel the fetus ; that is, maternal dystokia may be, 
and frequently is, dependent upon constitutional disturbances of 
the maternal system. 

A majority of the cases of maternal dystokia are due to some 
defect, disease or displacement of the genital organs or to disease 
of the maternal pelvis. Maternal dystokia may consequently be 
said to be either systemic or organic. 

I. Inadequate Expulsive Powers. 

Systemic causes of dystokia, of whatever kind, may be con- 
sidered in a single group, since they ultimately induce the one 
phenomenon of inadequate power, on the part of the mother, to 
expel a normal fetus, in normal presentation and position, 
through a normal birth canal. Anything which interferes with 
the general health of the animal and causes extreme emaciation 
or weakness may at the same time induce difficult labor, because 
of the feeble contractions of the uterine walls, as well as insuf- 
ficiency of the contractile powers of the abdominal muscles and 
diaphragm. It is consequently not rare to meet with cases of 
ill-fed animals, especially heifers or very aged cows, in which the 
general debility of the system .so affects the expulsive powers 
that labor becomes more or less tedious or difficult. 

During some seasons in certain communities, the hay or other 
food is of bad quality, the weather conditions may be bad, and 
other unfavorable conditions arise which .serve to cause great 
emaciation of entire herds or all the cattle of a district. In such 
instances maternal dystokia may become well nigh enzootic, es- 
pecially involving immature heifers and aged cows. 

Such maladies as osteomalacie, page 423, and paraplegia, 
page 431, are frequently accompanied by dystokia, the debility 
of the disease being accentuated by the decubitis. While volun- 
tary recumbency is not inimical to parturition, involuntary 
decubitis tends to cause dystokia. Hence disabling accidents, 
43 673 



674 Veterinary Obstetrics 

such as serious fractures and dislocations, wheu causing decubitis, 
tend strongly to induce maternal dystokia. 

Parturient paresis, in those rare cases where it attacks a cow 
prior to, or during parturition, inhibits the expulsive powers and 
causes dystokia. The fetus, though normal in size, presenta- 
tion and position, is not expelled, but lies in the inert uterus 
throughout the course of the disease, unless artifically extracted. 

The diagnosis of dystokia due to deficient expelling powers is 
to be based primarily upon the general condition of the animal, 
its emaciation and weakness, the presence of decubitus, and with 
these a fetus of normal size, form, presentation and position. 
The maternal passages are normal, and the os uteri dilated or 
dilatable, but there is an absence of vigorous expulsive efforts. 

The handling of dystokia of this character will depend upon 
the cause. If the feeble labor pains are referable to debility and 
emaciation, stimulants are indicated, combined with judicious 
traction. The case should not be left in the hope of a natural 
delivery, risking the exhaustion of the patient. 

We have already dealt with the dystokia of the ante-partum 
paralysis in the cow, and shall later consider the question of 
parturient paresis. 

2. Pelvic Constriction. 

The pelves of breeding animals may depart more or less from 
the normal, in such a waj' as to render parturition difficult or 
impossible. Pelvic constriction may be due to disease of the 
general system, or to deformity of the pelvis as the result of 
some accident. 

a. Rachitis. Rachitis is not at all rare among domestic ani- 
mals, but does not as a rule result in serious deformity of the 
pelvis, as is so frequently observed in woman. The principal 
part of the weight of the quadrupedal animal falls upon the 
anterior feet, so that the weight upon the pelvis is comparatively 
slight and not well calculated to cause pelvic deformity. Be- 
sides, the bones of most species of domestic animals are well 
advanced in ossification at the time of birth, and in rachitis tend 
rather to break than bend. This is especially true of horses, 
cattle and sheep, and in these we have no very good proof of 
serious rachitic deformity of the pelvis. In countries where 
swine are kept largely in styes, and upon a more or less limited 



Pelvic Constriction 



675 



diet, it is not rare to meet with rachitic deformity of the pelvis 
which leads to serious dystokia and renders it wholly impossible 
to extract the fetus through the pelvis. In a series of cases of 
dystokia recorded by De Bruin in the sow, (B. T. W., January 
3, 1907) the pelvis was so constricted from rachitis as to barely 
admit two fingers to pass through it. Hysterotomy became 
necessary. 

b. Callus from Healed Pelvic Fractures. We occasionally 
meet with fractures of the pelvis in which, when the animal 
recovers, there remains an enlarged callus, with perhaps some 
additional deformation by one fractured portion of the pelvic 
girdle pushing inward, so that it may greatly narrow and 
obstruct the pelvic canal, rendering birth through it exceedingly 
difficult or quite impossible. These cases are not very common, 
but occur in the experience of most veterinary obstetrists, and 
constantly suggest that a female which has suffered from a 
fracture of the pelvis should not be used for breeding purposes, 
except the pelvis has first been examined and found to be suf- 
ficiently wide to permit of safe birth. 




Fig. 112. Constricted Pelvis of Mare, inducing Irremedial Dystokia. 
Dislocation of Right Sacro-iliac Articulation. 
Green-stick Fracture through Right Acetabulum. 
Non-union of Fracture of Left Iliac Shaft. 



676 



Vetermary Obstetrics 



c. Unhealed Fractures of the Pelvis. We observed in 
one case a fracture of the pelvis in a sucking filly, Fig. 112, 
which was broken down by a large stallion. There was a dis- 
location of the sacro-iliac articulation, a green-stick fracture 
through the acetabulum, and a fracture through the shaft of the 
ilium. The latter failed to heal, but the fillj' recovered siiiS- 
ciently to get about. She was crippled, but in good flesh and vig- 
orous. Later she was bred without the pelvis having been ex- 
amined. At foaling time we were called, because of severe 
dystokia, and found the fetus presenting normally at the pelvic 
inlet ; but the pelvic canal was very constricted, and whenever 
we applied traction to the fetus it seemed to recede instead of 
advance. The foal could not possibly be extracted by traction 
because, on account of the non-united fracture on the one side 




Pig. 113 a. Cai,i.us due to Dislocation of the Femur 

OF Cow THROUGH THE FoRAMEN OVALE. 
A. Acetabulium. B. Exostosis from permaiieut dislocation 
of femur through foramen ovale. 



Pelvic Constriction 



677 



and movable sacro-iliac articulation on the other side, whenever 
traction was applied, the pubis moved toward the sacrum and the 
channel closed like a cam. The fetus was dead and the mare 
was worthless, so that delivery by other means was ignored and 
the animal was at once destroyed. 

d. Exostosis, as a result of dislocation of the femur 
through the foramen ovale. Fig. 113A illustrates the pelvis 
of a cow, in our collection, in which there has been an old stand- 
ing dislocation of the femur through the foramen ovale. As a 
result of the constant irritation there has developed a large ex- 
ostosis inside the pelvis, which would naturally cause serious 
obstruction in case of parturition. Exostoses or bone tumors 
may arise in the pelvic canal from various causes, and offer more 
or less serious obstruction to birth. 

e. Eminences along the ischio-pubic symphysis, Fig. 
113 B, are not rare in the pelvis of the mare. Their cause is 




Fig. II3B. Pei<vis of Mare. 

Showing prominent elevations, A, B and C on the anterior margin of 

the pelvic inlet. 



678 Veteri?iary Obstetrics 

unknown. Usually they present no evidences of being of patho- 
logic origin, but seem merely a deviation from the normal type 
of development. They occur chiefly upon the median line of 
the anterior pubic border, within the area of insertion of the 
prepubian tendon, and may be directed more or less forward and 
upward. At other times they are located, as in Fig. 113B, 
just posterior to the pubic brim along the symphysis, and project 
upwards into the pelvic cavity as a sharp cone. They more 
rarely occur along the ischial symphysis and elsewhere. . 

It is not impossible that they result from some disturbance of 
the nutrition of the general osseous system, and originate in a 
way corresponding to spavin and similar exostoses in other parts 
of the body. 

Whatever their cause, they constitute serious pelvic ob- 
structions when the time for parturition arrives. They differ, how- 
ever, in their significance, from the preceding classes. Though 
they offer some mechanical impediment to the passage of the 
fetus, unless the projection is very large the fetus may pass 
over. The chief danger is to the utero-vaginal walls, which, be- 
coming impinged between the conical projection and the fetal 
body, become contused, lacerated or perforated, to end finally 
in septic peritonitis. 

Handling. In the handling of this group of cases, three dis- 
tinct possibilities offer to the obstetrist. 

I. Prophylaxis. 
Should the veterinarian be consulted regarding pelvic in- 
juries to a female which might be used for breeding purposes, 
he should always consider whether the animal may later be 
safely bred or not. If the pelvis has been fractured, if there 
has been a coxo-femoral dislocation or disease, the possibility of 
changes in the dimensions of the pelvic canal should be con- 
sidered, the parts carefully examined, and, if necessary, the 
owner warned. Should the veterinarian be asked to examine 
the pelvis of a female with reference to her capability as a 
breeder, the various impediments should be carefully estimated 
and a judicious answer given. 

2. Artificial Abortion. 
Pelvic deformities of a character to induce dystokia may 
occur or become known during pregnancy, at a time when the 



Pelvic Constriction 679 

fetus is so small that it might safely pass the pelvic canal. 
In such instances, if it is clear that normal birth cannot take 
place, and the mother is prized aside from her power to breed, 
the question of inducing artificial abortion should be considered. 
If it seems that the life of the mother can thus be rendered more 
safe than by permitting the fetus to remain and develop until the 
normal time of parturition, then the operation should be per- 
formed . 

Artificial abortion may be induced in a variety of ways. 

a. It has been stated that artificial abortion may be brought 
about by the administration of ergot, savin and other drugs. So 
far as we have been able to learn, however, this plan of bringing 
about the expulsion of the fetus has not been successful in domestic 
animals, and the only cases recorded which have apparently 
succeeded are those where the life of the mother has been greatly 
imperiled through the toxic action of the drug. It seems that 
these medicines are as likely to kill the mother as the fetus. 

b. Irritation and Dilation of the Cervix Uteri. The hand 
may be introduced into the vagina and one or more fingers or 
the entire hand forced through the os uteri into the cervix of 
the uterus, thereby producing an irritation which may cause 
expulsive efforts and expulsion of the fetus. It seems, how- 
ever, that this plan possesses no reliability. While in some in- 
stances it may produce the expulsion of the fetus, in others 
it may not. 

c. In the larger animals we may readily carry the preceding 
operation further and, introducing the hand through the cervix, 
separate the fetal membranes from the maternal placenta, thus 
inducing uterine contractions with considerable certainty, 
especially in the mare. 

We may render this still more certain by puncturing the fetal 
envelopes. If we introduce the hand through the cervix, as 
already described, and then force one or more fingers through 
the fetal envelopes and permit the fetal fluids to escape, the fetus 
will ordinarily be expelled within 48 hours, providing the uterus 
is in healthy condition. As we have already noted on page 424, 
rupture of the fetal membranes and escape of the liquids may 
fail to induce expulsion of the fetus in amniotic dropsy. 

d. Vaginal irrigation with cold water, continued for 15 minutes 
every three hours, is said to bring about expulsive efforts and 



68o Veteri7iary Obstetrics 

evacuation of the uterine cavity, but this does not seem to be 
entirely reliable. According to Fleming it has certain dangers, 
especially that of metritis as a result of the shock. 

e. Dislodgement of Corpus I/Uteum. Hess, page 227, claims that 
the safest and best way to induce artificial abortion in the cow is by 
dislodging the corpus luteum by compression and then applying 
massage to the gravid uterus from before backward. In his 
hands this plan of inducing expulsive contractions of the uterus 
has proven highly efficient. 

3. Overcoming Dystokia due to Pelvic Constriction. 

When gestation has passed unheeded until the time for 
parturition has arrived, and the veterinary obstetrist faces a 
case of dystokia due to pelvic constriction, various plans for the 
removal of the fetus present themselves. 

a. Forced Extraction. First to be considered as affecting 
the lives of both mother and fetus is that of forced extrac- 
tion through the narrowed canal. If in the judgment of the 
veterinarian it is practicable to force the fetus through the 
canal without serious injury to the mother, this should be done. 
If forced extraction is decided upou, the operator should proper- 
ly secure the presenting parts, thoroughly lubricate the passages 
by means of a warm lysol solution, or otherwise, and proceed 
with the extraction under the general rules on page 586. 

If the fetus has already become advanced in the pelvic canal 
and is firmly impacted, it is difficult to do otherwise than to 
attempt the completion of delivery by means of traction. The 
fact that it has been forced along the passage for a considerable 
distance should be considered evidence that it may be com- 
pletely extracted without very great danger. 

b. Embryotomy may be po-ssible in the larger animals, but 
is not available in the smaller ones. We have already described, 
on page 641, the technic for carrying out embryotomy operations. 

e. Ceesarian Section. Finally, when other means for saving 
the life of the mother or fetus or both are excluded or 
rendered very doubtful by the conditions which are present, 
hysterotomy should be employed, under the general plan which 
has been suggested on page 663. 

This constitutes the most promising method for overcoming 



Pelvic Co7istriction 68 1 

pelvic coustriction in the sow, bitch and cat. When dystokia 
occurs in these animals from pelvic constriction, the obstetrist 
should definitely decide upon the course to pursue. If hyster- 
otomy is performed at all, it should be done at once, without 
first attempting forced extraction or other manipulations in the 
genital canal, since the inevitable insult to these parts and the 
exhaustion of the patient greatly complicate the case and seriously 
reduce the prospects for recovery should hysterotomy be later 
decided upon. 



RIGIDITY OR SPASM OF THE CERVIX UTERI. 

In the cow a condition is occasionally met with which is 
attributed to a spasmodic contraction of the cervix uteri, of such 
a character as to constitute a more or less serious obstacle to 
parturition. It is difficult to define clearly and definitelj' what 
constitutes rigidity or spasm of the cervix, and to differentiate 
between it and induration. At best this condition is largely a 
comparative one, and may be due as much to defective uterine 
contractions as to an abnormal contraction or spasm of the 
cervix. 

Symptoms. The symptoms by which, it is claimed, we may 
recognize rigidity or spasm of the cervi.x consist largely of a non- 
dilation of the cervical canal, in spite of the fact that the labor 
pains are apparently normal and that no disease of the cervix 
itself can be detected by examination. In describing the cervix 
of the uterus in ruminants, we noted its elongated and narrow 
canal the abundance of circular muscle fibers in its walls, 
with the large amount of connective tissue. This gives a very 
firm and rigid character to the normal organ. 

In one instance which came under our observation, the keeper 
of some pedigreed cows had one morning found, projecting from 
the vulva of a cow, the head of a fetus. The cow was at about 
the 6th month of gestation. The head of the fetus was re- 
moved by the attendant ; its body promptly dropped back into 
the uterine cavity ; the cervix contracted, and the canal was 
closed. The attending veterinarian failed to introduce his hand 
through the constricted cervical canal, and the fetus was allowed 
to remain in the uterus until thoroughly decomposed, when, 
some lo weeks later, the remains were expelled. Such would 
seem to be a well-marked case of rigidity of the cervix, because 
its dilatability had been proven by the fact that the head of the 
fetus had passed through it. Its rigidity was emphasized by 
the fact that the attending veterinarian was unable to introduce 
his hand through the cervix, through which the fetal head had 
passed but a few hours before. 

As one of the prominent sj^mptoms, we must consequently 
recognize first of all the existence of expulsive efforts without 
corresponding dilation of the cervical canal. Upon examining 



Rigidity of Cervix Uteri 6S3 

the latter with the hand, no actually diseased condition of it can 
be recognized. 

The prognosis of rigidity or spasm of the cervix of the uterus 
is usually favorable. Occurring almost wholly in the cow, where 
labor is frequently prolonged, and where the fetus may live for 
a long time, the rigidity usually gives way to the pressure of the 
fetal membranes or of the advancing portions of the fetus, in the 
course of 24 to 48 hours, and delivery is effected. The prognosis 
must depend to a great extent upon the position of the fetus in 
the uterus. If it chances to be in some vicious position, by 
which a very large ma.ss presents at the cervix, it may have little 
tendency to cause its dilation. We frequently observe great 
delay in the dilation of the cervical canal, when the fetus presents 
by its breech with both hind legs extended forward beneath the 
abdomen, because in such a case the buttocks are too blunt to 
act as a wedge. 

There are other cases in which the non-dilation of the cervix 
may be primarily due to debility on the part of the mother or 
to some debility or disease of the walls of the uterus. 

Treatment. In the handling of this condition it should be 
remembered that in the ruminant the process of parturition is 
usually deliberate and that, if the fetus is presenting normally 
and the mother seems to be well and strong, the veterinarian 
should be in no haste until some hours have elapsed after ex- 
pulsive efforts have become evident. 

When, however, labor becomes unduly protracted, and there 
seems to not be satisfactory progress, intervention upon the part 
of the obstetrist is advisable. The dilation of the cervical canal 
is indicated. He should resort first to the most simple means, 
such as the injection into the vagina, and if practicable also into 
the cervical canal, of warm emollient liquids, like a i % solution 
of lysol or bi-carbonate of soda. 

Various drugs have been suggested to overcome rigidity of 
the cervix. Presumably, any drug introduced into the general 
system acts alike upon all parts of the uterus, and while decreas- 
ing the spasm of the cervix, also decreases the expulsive powers 
of the organ as a whole. The chief drugs which have been ad- 
vised for this purpose are opium, chloral hydrate and chloroform. 
Some have advised the application of extract of belladonna to 



684 Veterinary Obstetrics 

the cervix uteri, while others contend that it has no real value. 
With this latter opinion we are in full accord. 

A more hopeful class of drugs, which we do not know to have 
yet been used, are the local anaesthetics. Stovaine, we know, 
induces marked muscular paralysis when injected upon a motor 
nerve. Cocaine and eucaine would probably prove serviceable 
but must be used with caution, lest poisoning follow. These 
may prove highly important in combination with mechanical 
dilation. 

The mechanical dilation of the canal is that to which final 
resort must be made. This frequently constitutes a very trying 
ordeal, which" may require much labor and patience. For this 
purpose the vagina and vulva should be well disinfected and the 
hand rendered unctuous by means of an aseptic or antiseptic oil 
or fat or by keeping it well moistened by means of a warm lysol 
solution. By passing the hand through the vagina to the os 
uteri, one, two or more fingers are pressed through the os. As 
the OS becomes somewhat dilated, the fingers are held in the form 
of a cone and, by a somewhat rotary motion, are forced further 
and further into the cervix, until finally the hand is pushed 
through into the uterine cavity, when a portion of the fetus may 
be grasped and secured, and the dilation completed from in front 
by drawing upon the fetus itself. 

It should be constantly remembered that the most effective 
direction for the application of the force is from in front, as in 
normal parturition, and consequently, the earlier we can apply it 
from this direction the better, and the easier the task. 

In one instance we were without mechanical appliances for 
dilating the canal, except obstetric instruments which were 
armed with olive-shaped handles tapering from the butt toward 
the point. After dilating the canal sufficiently to push one of 
these instruments through until the handle entered the uterus, 
we then introduced a second handle along the shank of the first 
instrument and forced it through also. Drawing simultaneously 
upon the two instruments brought the two handles together at 
the anterior opening of the cervix, and thus forced the cervical 
walls apart and dilated the canal far more effectively than we 
could have done by force applied from behind. 

Uterine dilators are made, which in our experience possess high 
efficiency and greatly lighten the labor of the mechanical dilation 



Indtiratioji and Atresia of the Cervix Uteri ' 685 

of the cervical canal. These instruments should be made very 
strong. Introduced through the canal closed, they are to be 
opened by means of a screw or other mechanism, and the cervical 
walls thus forced apart. 

Since most of these instruments open to a greater extent at 
the apex than at the base, they imitate the natural method for 
bringing about the dilation. While some patterns of dilators 
have their jaws open along parallel lines, those which are di- 
vergent, so that they open wider at their apex than at their base, 
are to be preferred. 

Some have suggested sponge-tents, in which a compressed 
piece of .sponge is introduced into the narrow cervical canal, left 
there to absorb fluids, thus to become greatly enlarged and 
force the walls apart. Others have suggested rubber bags of 
various forms, which may be introduced through the cervical 
canal empty and then dilated by having warm water forced into 
their interior. 

In our experience, however, it is best to rely upon the careful 
manual or instrumental dilation. This should be accomplished 
very gradually and with much care, since any violence may 
cau.se serious injury to the parts. 

Induration and Atresia of the Cervix Uteri. 

In the cow, and more rarely in other domestic animals, there 
occurs an induration of the cervix uteri, apparently the result of 
some injury or disease which has established a chronic inflamma- 
tion of the part and led to its thickening and becoming sclerotic, 
with a consequent narrowing or even closure of the cervical 
canal. In dealing with the anatomy of the cervix uteri, we 
have already noted in ruminants, and especially in the cow, that 
the cervix is usually highly developed and contains numerous 
circular muscle fibers, commingled with a large amount of con- 
nective tissue, which gives to the part a preeminently rigid 
character. 

This normal character of the cervix, with its slow response to 
the dilating influence of labor, tends constantly to induce injuries 
during parturition, which may later lead to a chronic inflamma- 
tion and thickening of the part, to eventually end in induration 
and a loss of dilatability. It is generally presumed to occur 
chiefly in cows which have previously given birth, and suffered 



686 ♦ Veterinary Obstetrics 

from cervical lacerations, retained afterbirth or other forms of 
local irritation. In our experience it has been confined to 
heifers. In one heifer the cervix was so hard and unyielding 
that, in forcing the fetus through the narrowed cervical canal, 
the cervix was torn asunder, leaving a wide rent into the perito- 
neal cavit}'. 

The induration may lead to a condition which will admit of a 
moderate degree of dilation, permitting the fetus to pass with 
more or less difficulty ; or to complete atresia of the canal. Be- 
tween these two extremes there may be every possible variation. 

The symptoms of induration and atresia of the cervix do not 
appear until parturition sets in and expulsive efforts have become 
established, when it soon becomes evident that there is some 
serious obstacle to birth. Although the expulsive efforts may 
be vigorous, and to all external appearances everything may 
seem normal, there is nevertheless little or no progress. 

In the milder cases the fetal membranes may protrude and 
rupture, or even some portion of the fetus, especially one or two 
extremities, may advance along the vaginal canal and appear at 
the vulva ; but, regardless of the expulsive efforts, no substantial 
progress is made. The constriction continuing day after day 
unless relief is given, the placenta may finally come away, leaving 
the fetus behind, and the expulsive efforts may cease, while 
the fetus undergoes putrid decomposition. The cow may 
apparently recover her condition, or may succumb to septicaemia, 
with all the symptoms attendant thereon. 

The diagnosis of induration and atresia of the cervix must de- 
pend primarily upon the revelation of the condition to the sense 
of touch upon manual exploration. When the veterinarian ex- 
amines the genital canal he finds that the os is more or less com- 
pletely closed, that the cervical canal is largely undilatible, 
and that the walls of the cervix are hard, tense and unyielding. 
In some cases the walls of the cervix are evidently greatly thickened 
for a considerable distance, while in others the diseased condition 
may be limited to the vaginal portion of the cervix. 

Perhaps one or more fingers, or even the entire hand, may be 
passed through the cervical canal, but beyond this degree no 
dilation may seem practical, and the parts are exceedingly dense 
and rigid to the touch. 



Induration and Atresia of the Cervix Uteri 687 

Induration or atresia is to be difEerentiated from spasm of the 
cervix, which is purely temporary in character and may yield 
with comparative promptness to mechanical dilation or somewhat 
later to the natural dilating forces of the expulsive powers. In- 
duration is also to be distinguished from mahgnant or other new 
formations, such as carcinom, sarcom, actinomycosis or tuber- 
culosis. These diseases usually reveal to the sense of touch a 
diseased state of the tissues, with a tendency to bleed upon be- 
ing handled. 

The prognosis of induration or atresia of the cervix uteri will 
depend very largely upon its location and extent. When con- 
fined to the vaginal portion of the cervix uteri, the prognosis is 
distinctly favorable, because this portion admits of the freest 
possible manipulation and operation without imperiling the in- 
tegrity of the walls of the organ. When the induration is more 
extensive, and involves the anterior portion of the cervix or its 
entire length, the prognosis becomes more serious because any 
extensive operation or accidental tear during the extraction of 
the fetus may bring about a perforating wound communicating 
with the peritoneal cavity, and lead to the death of the animal. 

Handling. Three courses of handling are open for consider- 
ation ; manual or mechanical dilation, followed by forced extrac- 
tion of the fetus ; dilation by incision or vaginal hysterotomy; 
and gastro- hysterotomy or Caesarian section. 

Forced dilation of the cervical canal and extraction of the 
fetus should be attempted only in those instances where the vet- 
erinarian feels confident that it may be accomplished without 
serious mutilation of the cervix. If it appears that forcing the 
fetus through the canal would probably cause extensive tears, 
and perhaps penetrant wounds of the cervical walls, forced ex- 
traction should be abandoned. The os uteri and cervical canal 
are first to be gradually dilated with the hand or uterine dilator, 
until the operator may introduce his hand into the uterine cavity. 
The fetus may be secured by the presenting extremities, each 
carefully arranged in its proper position, and the cervical canal 
thoroughly lubricated, after which traction may be applied slowly 
and judiciously and the fetus forced away. The general direc- 
tions for the application of traction have been given on page 586. 

Vaginal Hysterectomy. The dilation of the cervix by in- 
cision, or vaginal hysterotomy, is usually to be preferred to forced 



688 Veteti?tary Obstetrics 

extraction or other means for bringing about delivery. If it is 
probable that forced extraction would cause more or less exten- 
sive ruptures in the cervix, the veterinarian may often guide and 
control these injuries by means of proper incisions. When the 
induration or atresia involves only the vaginal projection of the 
cervix, and the anterior portion is normal, the operation is 
simple and readily performed. 

In such a case the operator introduces a scalpel or bistoury 
and makes one, two or three incisions in an upward or lateral 
direction, sufficient to bring about the required dilation of the 
part. The depth, number and direction of the incisions must be 
based upon the amount of dilation required and upon the thick- 
ness of the muscular walls. The direction of the incisions 
should usually be upward or to the right or left. It is better 
that they should be numerous rather than deep, because, if a 
certain degree of dilation is to be attained and but one incision is 
made and the fetus is then forced into the rigid cervix, the 
yielding will take place almost exclusively at the one point 
weakened by the incision, while the other portions remain un- 
dilated, thus leading to an extensive and dangerous rupture. 

After the incisions have been completed, the presenting ex- 
tremities of the fetus should be secured and properly placed, 
the cervical canal freely lubricated, and the fetus slowly and 
cautiously extracted. 

After the extraction of the fetus, careful examination of the 
cervix should be made for perforating wounds into the peritoneal 
cavity. If the organ is intact and the fetus has been dead and 
has begun to decompose, it may be desirable to flush out the 
uterine cavity with an antiseptic solution. If there is a pene- 
trant wound into the peritoneal cavity, the introduction of an anti- 
septic in a large volume is exceedingly dangerous and improper, 
and other means should be taken for cleansing the uterus. Any 
liquids present may be drawn off by means of a siphon. The 
fetal membranes should be removed as promptly as is practicable, 
and if they cannot be removed with safety they should be kept 
as nearly antiseptic or aseptic as is possible, by the introduction 
of liquid disinfectants, or dry antiseptics such as powdered boric 
acid or iodoform. 

Caesarian Section. Finally, if forced extraction and the 
surgical dilation of the cervix are each impracticable, Caesarian 



Induration a7id Atresia of the Cervix Uteri 689 

section, as described on page 663, should be performed at a 
sufficiently early period to give the best opportunity for the 
saving of the lives of the mother and fetus. The operation leaves 
the animal worthless for breeding purposes, the common fate of 
induration or atresia of the cervix, however handled. It is only 
in exceptional instances that the veterinarian can properly advise 
an owner to again attempt breeding from an animal which has 
required surgical aid in parturition as a result of cervical atresia 
or induration. 

Fleming cites a number of recorded instances of induration and atresia of 
the cervix uteri. We have met veith two noteworthy instances, both in the 
cow. The first was in a two-year-old heifer, in which case the os uteri was 
opened sufficiently to admit the passage of the hand, by which means the 
two anterior feet and head were secured, and traction cautiously applied. 
The extraction of the fetus was very gradual, and the traction applied was 
not severe, consisting of the combined power of two men. The progress 
was verj- slow. The two anterior limbs were easily brought through the 
cervix into the vagina and pelvic canal. Later the head also passed through, 
but when the chest was reached there seemed to be a halt. 

Finally during a vigorous expulsive effort, while traction was being 
applied, there was a loud tearing sound, the fetus advanced rapidly without 
severe traction and was quickly delivered. The calf was alive. Upon ex- 
amining the uterine cavity, a great rent was found in the cervical canal, 
about 10 inches long, which penetrated the peritoneal cavity. Fortunately 
it was directly at the top of the canal and conseqiiently was advantageously 
situated in reference to escape of uterine contents into the peritoneal cavity. 
The heifer recovered without incident. 

The second case was also in a heifer, but in this instance a 3-year-old and 
of the Polled Angus breed. The pregnant heifer was kept at pasture in a 
place where she was not under close observation. At about the normal 
time for parturition, the owner noted the fetal membranes protruding from 
her vulva and assumed that she had given birth to a calf. The heifer 
showed some slight e.xpulsive efforts, which he attributed to a retention of 
portions of the afterbirth. 

In a general way she recovered from the ill-effects of fetal retention, and 
kept in good condition. She was taken from the pasture and was milked, 
yielding about two gallons per day. Her appetite and general health 
seemed to be good, except that at intervals she was affected with a fetid 
diarrhea, which soon passed off. Ten weeks later we were called in con- 
sultation, and upon e.xploration found the os uteri constricted, permitting 
the introduction of but two or three fingers, while through it protruded a 
portion of the tail of the fetus. The constriction was confined to the vaginal 
portion of the cervix, so that the finger or fingers entered the fully dilated 
cavity. 

44 



690 Vete7'inary Obstetrics 

With an ordinary bistoury, the os uteri was sufficiently dilated, by cutting, 
to allow of the ready insertion of the hand. Introducing the hand into 
the uterus, we encountered the remains of the fetus there being re- 
cognizable the tail and a small fragment of the skin of the buttocks. Be- 
yond lay an inextricable mass of fetal bones, which had separated into 
their basic parts, the shafts and epiphyses being separated from each other. 
Deep down in the anterior part of the uterus there was found an accumula- 
tion of whole grains of corn and other foods. Along the left side of the 
uterus there were two openings, which would admit of the passage of one 
or two fingers directed toward the rumen. Apparently the uterus had be- 
come adherent to the rumen, and portions of the fetus had sloughed into 
that organ and, passing out through the intestinal canal, had caused the 
fetid diarrhea which the owner had observed. 

The walls of the uterus were hard, immensely thickened, and wholly de- 
void of contractile power. Judging from the sense of touch, the walls 
seemed to be more than one inch thick. 

There was no unfavorable reaction to the operation, and the heifer con- 
tinued her usual flow of milk. Later she was fatted and sent to market. 

Malignant and Other Newgrowths Involving the 
Genital Passages. 

Veterinary literature records occasional cases of malignant 
tumors or other diseased growths in the cervix uteri and other 
portions of the genital tract. They are very rare, and very di- 
verse in character. The symptoms are frequently unlike those 
of induration or atresia of the cervix in that their presence may 
be revealed by symptoms before the end of gestation. Naturally, 
they probably develop chiefly after impregnation, because, were 
they present and had acquired any great development before 
breeding, they would probably prevent fertilization. 

They may be of the nature of carcinom or sarcom and, more 
rarely, of actinomycosis or tuberculosis. 

During pregnancy their presence may be revealed or suggested 
by the existence of a vaginal discharge, accompanied possibly by 
some constitutional symptoms of debility, especially in cases of 
malignant tumors. 

If not revealed by the presence of discharge during gestation, 
they may be discovered because of their acting as an impediment 
to parturition. When the veterinarian is called .because of 
dystokia, and examines the patient, he recognizes the tumor by 
touch. 



Malignant and other Newgrowths 691 

The prognosis is highly' unfavorable if the tumor is malignant 
because, although it may be possible to deliver the fetus, the life 
of the mother cannot usually be greatly prolonged, and the disease 
itself is generally beyond remedy. The disturbance of parturi- 
tion is quite inclined to arouse the disease process to renewed 
activity. 

Should the tumor be of a benign character, and its anatomical 
relations permit removal, the prognosis is favorable. 

The handling of the dystokia is to be based upon the char- 
acter of the tumor. If malignant, the chief aim should be the 
saving of the life of the fetus, if of value. Partial or complete 
removal of a malignant tumor of the genital canal may be war- 
ranted in order to remove the obstruction to birth, and the fetus 
may then be delivered through the birth canal. If the tumor is 
irremovable and offers serious obstacle to delivery, gastro-hyster- 
otomy may be performed to save the life of the young. 

Benign tumors interfering with parturition should be removed. 

Numerous other minor impediments to parturition occur very 
rarely in the genital canal. 

Adhesions and constrictions in the vulvo-vaginal canal offer 
at times more or less serious impediments to parturition, which 
may lead to important lacerations of the soft parts. 

Persistent hymen is occasionally met with in cases of dys- 
tokia, but, so far as we have observed, consists of thin bands, 
stretching from floor to roof between vulva and vagina but taking 
no part in the causation of the dystokia. They are easily 
ruptured with the fingers. 



DYSTOKIA DUE TO DISPLACEMENTS OF UTERUS. 

a. Hernia of the Uterus, or Hysterocele. In considering 
the accidents and diseases of the pregnant female, we have already 
had occasion to refer on page 436 to the rupture of the prepu- 
bian tendon, and to other forms of uterine hernia by which the 
gravid uterus may escape through an opening in the muscular 
walls of the abdomen. In considering those accidents, we neces- 
sarily dealt with their causes, prevention, and method of 
handling. 

b. Deviation of the Uterus. Various writers describe a dis- 
placement of the uterus obliquely downward, which they com- 
pare with ante-version of the gravid uterus of woman. The ex- 
act condition is not very clear. According to Fleming, when the 
hand is introduced into the vagina it reaches an imperforate cul- 
de-sac, which consists of the floor of the uterus pushed up against 
the floor of the vagina, thus projecting into the pelvic cavity, 
while the os uteri is situated high toward the sacrum and is not 
much dilated. The fetus lies beneath the vaginal floor and cor- 
responds somewhat in its position to what we describe on page 715 
as bi-cornual or transverse development of the fetus. 

While considering the location and attitude of the fetus in preg- 
nant animals, on page 379, we have recorded occasionally finding, 
during the later stages of gestation, an extremity of the fetus, 
usually the head and two anterior feet, projecting into the pelvis 
or immediately against the pelvic inlet, either above the vagina 
or alongside of it, but we did not consider that this was abnormal. 

Fleming, citing Garreau, relates one case in which, in this 
deviation, the os uteri was closed and the cervix was thickened 
and indurated. Later it became necessar)^ to perform Caesarian 
section, by which the life of the cow was saved. This seems 
rather to have been induration of the cervix. 

In another case, described by Schaack, the fetus was in a 
normal position and was extracted, but the cow died almost im- 
mediately from an extensive rupture in the floor of the uterus, 
which led to a fatal hemorrhage, in a similar way, apparently, to 
what we record as a common consequence of forcible extraction 
in cases of bi-cornual development of the fetus. 
692 



Torsion of the Uterus 693 

It would appear, therefore, that under this head veterinary ob- 
stetrists include a group of diverse conditions. 

The handling of such cases must be based upon the actual 
character of the obstacle to birth. When practicable, the fetus 
should be removed by traction. 

c. TORSION OF THE UTERUS. 

Torsion of the gravid uterus, or revolving of the organ 
upon its long axis, is an accident which belongs to quad- 
rupedal animals. The displacement occurs most frequently 
in uniparous animals, and especially in ruminants. It is 
most frequently diagnosed in the cow. It is common in the 
ewe. In the cow it occurs chiefly in dairying districts where 
the animals are kept confined in stanchions and where, as a con- 
sequence, they are subjected to certain violent movements, 
especially of slipping in getting up on a wet floor or in making a 
misstep into a deep gutter. It is comparatively rare in the 
mare, and even more so in the small, niultiparous domestic 
animals. 

Historically, the accident has been recognized for more than a 
century, and has been well known and studied in every country 
where much attention is paid to dairying and the breeding of 
cattle. 

The anatomical relations of the uterus largely determine the 
probability of torsion. The ovaries are formed, page 17, near 
the Wolffian bodies, and the broad ligaments extend from these 
backward to, and including, the vagina, maintaining the geni- 
tal canal in its position in the abdominal cavity. In all animals 
the ovaries drop more or less into the abdominal cavity, and tend 
to move backward toward the inguinal ring. As the ovaries 
retreat backward, the broad ligaments tend to follow them, so 
that their most anterior attachments pass back toward the 
inguinal ring. Consequently, the fixation of the uterus becomes 
more and more posterior as the ovary moves backward. 

This migration of the ovary, and the consequent moving back- 
ward of the broad ligament, is most marked in the ruminant, and 
consequently when the animal becomes pregnant the gravid 
uterus soon projects far anterior to its ligamentous attachments 
to the abdominal walls. There is little to prevent the projecting 



694 Veterinary Obstetrics 

portion of the gravid uterus from revolving upon its long axis, 
and once it has thus become displaced there are virtually no 
natural means for its replacement. 

An additional factor in torsion of the uterus, which has 
perhaps been over-emphasized by some obstetrists, is that, in the 
uterus of the cow, the cornua curve downward, backward and 
then upward, instead of curving upward and forward as in the 
mare and most other animals, and that the broad ligament is 
attached at first to the inferior side of the uterine cornua. This 
in itself renders the organ unstable when it becomes gravid, and 
it tends to make a partial revolution upon its long axis before it 
can come to rest in a stable position upon the abdominal floor. 
Some writers look upon this peculiarity in the conformation of 
the organ itself as the chief factor in the frequency of torsion in 
the cow, but it probably plays a very minor part. 

The accident, in the larger animals, consists of the revolution 
of the gravid uterus upon its long axis, in which process its 
broad ligaments must become involved. The torsion shows it- 
self chiefly in the cervix and vagina. When the organ turns 
upon its long axis, the broad ligaments are necessarily carried 
along with it, and more or less incarcerate the organ, as if they 
were tense cords wound spirally about it. 

In the smaller, multiparous animals, torsion usually involves 
one cornu only. 

The gravid organ in torsion behaves very much the same as a 
stout bag filled with fluid contents. If such a bag is attached at 
one end, and we attempt to revolve the free extremity upon its 
long axis, the spiral constriction will occur, not in its middle but 
at the end where it is attached and constricted by its mouth be- 
ing tied shut. In the distended uterus, when it revolves upon 
its long axis, the actual twist or spiral occurs ordinarily, not in 
the uterine body or in the cornua, but in the constricted neck or 
in the empty vagina just beyond. The method by which this 
torsion is brought about is well demonstrated in Figs. 114-116. 
The torsion may occur with equal facility to the right or to the 
left. If the upper portion of the uterus turns to the right, while 
the floor passes to the left, it is known as right torsion ; if it 
revolves in the opposite direction, it is known as left torsion. 

The torsion may be of any degree compatible with the integ- 
rity of the organ. As a general rule, it is scarcely recognizable 



Torsion of the Uterus 



695 



unless the revolution has reached the quadrant of a circle, 90°, or 
what some obstetrists know as quarter torsion. If the torsion 
continues until the uterus has made a complete revolution upon 
its long axis, it is known as complete torsion. Some writers 
would have us believe that the uterus may make four complete 
revolutions. This assumption or statement is open to question. 
It cannot well go very far beyond a complete revolution, until 
the strain upon the organ becomes too great, and it twists off or 
ruptures transversely and drops, an inert bag, into the abdominal 
cavitv. 





Fig. 114. The Mechanism of Torsion of the Uterus in theICow. 
Gravid Uterus in Normal Position at about the 7TH 
MONTH of Pregnancy, Seen from Below. 

P, Pubis. B, Bladder. L, Broad ligament. 
L', Point of attacbment of broad ligament to abdominal wall. 
O, O, Ovaries. C, Right cornu. C, Left I non-gravid ) cornu. 
A, Corpus luteum. 



696 Veterinary Obstetrics 

The causes of torsion have not been fully determined. Any- 
thing which may violently disturb the uterus may cause it to 
turn upon its long axis. We have noted the peculiar anatomical 
relations of the uterus of the cow. Another peculiarity is 
that when she gets up she rises first upon her hind "feet, 
which causes the gravid uterus to hang half suspended by the 
vagina in the abdominal cavit3^ When thus partially suspended, 
any slipping upon a wet floor or misstep into a deep gutter may 




Fig. 115. The Mechanism of Torsion of the Uterus in the Cow. 

One-hai<f Revolution of the Gravid Uterus on its Long 

Axis at about the 7Th month of Pregnancy. 

Lettering same as Fig. 1 14. 



Torsion of the Uterus 



697 



cause such a disturbance of the semi-pendulous organ as to cause 
it to revolve more or less completely upon its long axis. 

Any movement of the animal which might cause a sudden im- 
pact upon the gravid uterus, such as a fall, a severe slip, run- 
ning, jumping, or the jostling which animals get in transit upon 
railway trains, may accidentally cause the gravid uterus to 
revolve upon its long axis. 

In one instance observed by us, a mare had the habit of climb- 
ing up the sides of a large stack of straw, and would then lie 
down in such a way that she was unable to get up except by 
rolling over backward. In several instances the owner was com- 
pelled to turn her over in this way and let her roll down the side 
of the straw stack before she could regain her feet. When foal- 
ing time came she died because of torsion of the uterus. 




FiG.^ii6. The Mechanism of Torsion of the Uterus in the Cow, 
Complete Revolution of the Gravid Uterus at 

about the 7TH month OF PREGNANCY. 

Lettering same as Fig. 114. 



698 Veterinary Obstetrics 

The belief that the rolling of the animal, or some similar move- 
ment, such as a slip, which causes the body to very quickly re- 
volve to a slight degree, is the cause of torsion, is borne out by 
the results of our most common form of handling of this diffi- 
culty, the rolling of the animal. 

Some believe that violent movements of the fetus exert an 
influence in the production of torsion, but this cannot be deter- 
mined. The fetus may move violently because of partial as- 
phyxia after the torsiou has occurred, and this fact may be 
mistaken for the cause of the torsion. 

Symptoms. The symptoms of torsion of the uterus are not 
diagnostic without the aid of an examination of the organ itself. 
Soon after the torsion occurs, there is more or less pain caused 
by the displacement of the organ, which may be expressed in a 
variety of ways, according to the degree of torsion and the 
period of gestation at which it occurs. In the simpler cases the 
pain is expressed by kicking at the belly, lying down and 
quickly getting up again, looking at the side, switching the tail, 
with other symptoms which might be regarded as those of colic. 
In addition to these colicky symptoms, there may be present 
more or less marked expulsive efforts, which may somewhat 
closely resemble normal labor pains, or may partake rather of 
the character of straining to defecate. 

The general condition of the animal is variable. There may 
be a well marked loss of appetite, accompanied by more or less 
constipation of the bowels. When the torsion becomes more 
complete, and the blood supply to the uterus is largely or wholly 
interrupted, the fetus usually undergoes death and decomposi- 
tion, followed by great weakness of the animal. There are then 
such symptoms as would be caused by the presence of an emphy- 
sematous fetus and an inflamed or gangrenous uterus, with the 
resulting extensive peritonitis combined with septicaemia. When 
the septicaemia and peritonitis do not result fatally, the contents 
of the uterus, undergoing putrid decomposition, act as an abscess, 
which eventually ruptures through the abdominal walls or into 
the digestive tract, and the fetal remains escape in this way. In 
other cases the fetus is said to undergo mummification, followed 
by recovery of the patient. This must be extremely rare. We 
have observed no such case, or authentic record of such. 

Frequently the owner or caretaker fails to observe any signs 



Torsion of the Uterus 699 

which would lead him to suspect serious accident. The animal 
simply becomes dull, or if colic is present it passes unobserved, 
and it is not until the torsion has existed for days or even weeks 
that it has caused a sufficient disturbance to finally attract his 
attention. This is especially true of those who keep but a few 
cows and are about them but little. Cows at pasture are often 
scarcely seen at all, or merely are noticed for a few minutes each 
day, so that, unless there are very evident symptoms of disease, 
they pass unseen. In this way, it has been our experience that 
torsion of the uterus frequently passes unnoticed for a week or 
two, except that the owner may have recognized the fact that 
there was something amiss with the animal, though not in his 
judgment of a sufficiently serious character to call for veterinary 
attendance. In some cases of uterine torsion, the vulva seems 
smaller and drawn inward. 

The diagnosis of the accident in the larger animals is com- 
paratively easy by either vaginal or rectal exploration. Ex- 
amined per rectum, the anterior part of the vagina and the cer- 
vix of the uterus appear as a more or less tense, spiral cord, in 
which the spiral folds of the organ can be somewhat readily felt 
and' the direction in which the torsion has taken place may be 
determined. 

When the hand is introduced into the vulva, it does not ad- 
vance far until it comes in contact with the spiral folds in the 
vaginal walls, which pass in a spiral manner, either to the right 
or left, obliquely toward the os uteri. In some cases these spiral 
folds are not very prominent and the vagina is not closed, so 
that the veterinarian may, without serious difficulty, advance 
his hand to the os uteri ; sometimes he may be able to pass the 
cervical canal and reach the cavity of the uterus. 

In severe cases of torsion this cannot be done, but the hand, 
after following the folds of the vaginal wall in a spiral manner 
for a time, can be advanced no further. In some cases the hand 
can barely be introduced to the os uteri, and in others it stops 
before the mouth of the uterus is reached. 

This condition of the vagina is sufficient in itself to clearly 
identify the torsion, and renders the diagnosis definite. 

Pathology. The changes taking place in the uterus and its 
contents, in cases of torsion, must depend very largely upon the 
extent of the displacement of the organ. In mild cases, where 



yoo 



Veterinary Obstetrics 



the torsion is but slight, it does not interfere seriously with the 
circulation of the uterus and the nutrition of the fetus. The con- 
tractile power of the uterine walls remains essentially intact, and 
the life of the fetus may not be threatened except by delay in its 
expulsion, caused by the narrowing of the birth canal, owing to 
the partial revolution of the organ. In such slight cases the 
torsion merely constitutes a mechanical impediment to partu- 
rition, which, if not relieved, may finally end in the death of the 
fetus, to be followed by the ordinary consequences of fetal death 
and decomposition. Such mild cases are recorded, but have not 
been seen by us. 

When the torsion is extensive, it directly interferes with the 
circulation in the uterus, and secondarily with the nutrition of 
the fetus. As shown in Figs. 114-116, whenever the uterus re- 
volves upon its long axis all the blood vessels become more or 
less incarcerated, so that the circulation is very promptly dis- 
turbed or ma}' be completely cut off. This applies equally to 
vessels arising from the pudic or ovarian vessels. As soon as the 
circulation is disturbed, the effect upon the uterus is more or less 

01 

c 




Fig. 1 17. Torsion of Uterus. Cow. 
V, Vagina. OE, Os uteri exlernum. OI, Os uteri internum. 
BL, Broad ligament. C, Cotyledon. U, Uterine cavity. 



Torsion of the Uterus 



701 



profound, according to the degree of obstruction. Moderate ob- 
struction to the circulation tends to cause congestion of the 
uterine walls and placenta, accompanied by pain and symptoms of 
colic, with possibly more or less evident expulsive efforts. This 
obstruction, affecting first the venous circulation, tends to cause 
asphyxiation of the fetus. As a result of this disturbance of the 
circulation, the fetus may show more or less violent movements, 
which may sometimes be misinterpreted and believed to be the 
cause of the displacement, whereas in fact they are the result of 
it. The disturbance in the circulation and the non-aeration of the 
blood of the fetus tend finally to bring about its death, and this 
usually occurs after a comparatively short time if the torsion is 
at all extreme. 

The interference with the circulation affects first the return of 
the venous blood from the placenta, and as a consequence there 
is a constant tendency to an extensive transudation of serum 
and blood, into the uterine cavity and the fetal membranes. 




UC 

Fig. 118. Sagittal Section of Fig. 117. 

OE, Os uteri externum. OI, Os uteri iuternum. 
BL, BL, Broad ligament. 

V, V, V, Veins distended with coagulated blood. 
U, Uterus. U, C, Uterine cornu. 



702 Veterinary Obstetrics 

The transudation involves the uterine walls also, causing them to 
become immensely' thickened, injected and black ; the maternal 
and fetal placentas undergo analogous changes; the fetal mem- 
branes become involved ; and extensive exudation of bloody 
serum occurs in the uterine, allantoic and amniotic cavities, in- 
creasing enormously the volume and weight of the gravid organ. 

It is said that in some cases the fetus undergoes mummifica- 
tion, but if this occurs it must be very rare. The tendency is 
rather for infection of the uterus and its contents to take place 
and lead to putrid decomposition. Under normal conditions, 
the cervix uteri acts as an efiicient guard against infection. The 
cervical canal is hermeticallj' sealed with a mucous plug. When 
torsion occurs, the tissues of the vagina and cervix at once lose 
their normal function and, when the torsion is extreme and the 
vitality of the walls becomes depressed or destroj'ed, their 
bactericidal power declines or ceases, and they serve rather as a 
favorable culture ground for bacteria, which consequentl}' ad- 
vance to the uterus and its contents, either along the cervical 
canal or through the tissues, and thus cause fetal decomposition 
and septic metritis. 

It has been stated bj' some veterinary' obstetrists that the 
torsion of the uterus may take place at any point, or nearly so, 
in the entire organ in the vagina, the cervix or body of the 
uterus, or in the cornu. A study of the figures presented will 
answer this question. If we examine the gravid uterus, as shown 
in Figure 114, and revolve it upon its long axis, as has been 
done in 115 and 116, we find that we are dealing essentially with 
a large bag, containing solid (fetus) and liquid contents, in 
which the fundus of the uterus or the gravid cornu represents 
the bottom of the sac, while the cervix and vagina represent the 
closed mouth, which is fixed to the immovable vulva. 

Attempting to revolve this bag upon its long axis, we at once 
find that it will twist only at or near its point of fixation, where 
its mouth has been closed. If the uterus were empty, it could 
admittedly twist at any point throughout its entire extent, but 
when completely filled this cannot occur. Instead, if it were 
forcibly revolved and forced to begin to twist in this part, it 
would be torn asunder because the contents do not permit of 
an}' decrease in volume. Therefore, in cases of uterine torsion 



Torsion of the Uterus IOt, 

in tinipara, the twist must occur in the cervix and vagina and 
not elsewhere. 

The suggestion that the gravid cornu may possibly be the only 
part involved in a twist is untenable, in so far as it relates to uni- 
parous animals, where a portion of the fetus has developed and 
lies within the uterine body. In multipara, like the .sow, bitch 
and cat, torsion of one of the cornua may and does occur, and is 
more pro?jable than the torsion of the entire uterus. 

De Bruin suggests that, in a large proportion of the cases of 
torsion, the accident occurs after the os uteri has ?jecome dilated, 
and that it is favored by this fact. He ba.ses his belief upon the 
clinical fact, that, in a large proportion of cases of uterine tor- 
sion, when it is reduced, the cervical canal is found dilated and 
ready for the pas.sage of the fetus. We are not wholly ready to 
accept his conclusion. We have likened the gravid uterus to a 
bag filled with fluid. If we leave the mouth of the bag open, 
retaining its contents, attach it to an immovable object and 
attempt to turn it upon its long axis, we find this very difficult 
or even impo.ssible. 

De Bruin reasons that, because the uterus is contracted, there 
is more room for it to twi.st, but the uterus is certainly just as 
thoroughly filled, if not more so, than before it began to con- 
tract, unless the waters have escaped. The common clinical 
fact, that the cervical canal is found dilated in some cases im- 
mediately after torsion is reduced, may readily be explained by 
the torsion itself. In torsion, the cervix becomes very much 
stretched longitudinally, and this is one of the greatest elements 
in the dilation of the cervical canal. The tonsion, by involving 
chiefly the cervix, would destroy first of all its contractile power, 
very greatly weaken its mu.scles and tend to favor dilation as 
soon as the torsion is reduced. De Bruin admits this weakness 
of the cervical walls, and cautions the ob.stetrist against applying 
great force upon the fetus after reduction of the torsion, lest the 
cervix rupture transversely, but this would scarcely occur ex- 
cept the muscles had been seriously damaged by over-tension. 

When the fetus becomes emphy.sematous or undergoes putrid 
•decomposition, and the uterine cavity becomes filled with tran- 
suded liquids, the disease processes are not confined to the inner 
surface of the uterus and to its contents, but extend to and beyond 
the peritoneal covering of the organ. The peritoneal covering 



704 



Veterinary Obstetrics 



of the uterus becomes inflamed, and finally tends to adhere to 
other portions of the peritoneum with which it comes in contact, 
so that in one case observed by us, almost the entire peritoneal 
surface of the uterus was very firmly adherent to the intestines, 
rumen, bladder and abdominal walls. In addition to these ad- 
hesions, in severe cases, the peritoneal cavity contains an abnor- 
mal amount of a reddish-colored serum. 

Not only does the uterus become adherent to surrounding 
organs and tissues, but one part of the organ becomes firmly ad- 
herent to another part of it or to its broad ligaments, especially 
about the cervix, so that even if the rest of the organ is free from 
adhesions it may be difficult to untwist it because of adhesions 
existing between the coils in the twisted portion itself. 

When the torsion continues to an extreme degree, the organ 
and its broad ligaments give way, and the uterus, with its con- 
tents, becomes almost or wholly detached and lies free within 




Fig. 119. Torsion of the Uterus in Ewe. 

Followed by transverse rupture of the vagina and sloughing of the 
putrid fetus through the abdominal floor. 

A, Vulva. E. Ovary. 

B, Vaginal stump. ' F, Uterine cornu. 

C, Broad ligament. G, Intestine. 

D, Cord-like cervix, entwined by broad ligament. 



Torsion of the Uterus 705 

the peritoneal cavity. Just how far uterine torsion can advance 
in the living animal is a question not readily determined. Flem- 
ing, in his Veterinarj' Obstetrics, Edition 1887, page 299, states 
that the uterus may make as many as four complete revolutions, 
but cites no cases which clearly demonstrate the correctness of 
such a conclusion. In our own experience, the constant tend- 
ency has been for the organ to rupture transversely whenever 
the torsion extends to an extreme degree. In Fig. 119, trans- 
verse rupture of the uterus in the ewe is shown. In this 
case the fetus and other uterine contents sloughed out 
through the abdominal floor in the region of the umbilicus. 
How many times this uterus had revolved before it had torn in 
two cannot be determined, but apparently not much, if any, 
beyond one complete revolution. We question very much if, 
under ordinary conditions, the pregnant uterus, when near the 
close of gestation, will turn more than once or once and a half 
around without serious danger of a transverse rupture. 

In one instance, in the cow, which came under our observa- 
tion, it would seem that the torsion did not exceed one complete 
turn because it was very promptly reduced by rolling the cow 
once over. Yet, when the fetus had been removed, a large trans- 
verse rupture was found, which later ended in the death of the 
animal. We do not believe that we caused this rupture in deliv- 
ering the calf, as this was accomplished very gently and easily. 

Some authors state that occasionally the broad ligaments of the 
uterus also become ruptured, and make their statement in such a 
way as to carry the impression that the ligaments rupture inde- 
pendently of the transverse rupture of the organ itself. How 
true this may be, is not quite clear to us. When the organ rup- 
tures transversely, as in Fig. 1 19, it is very evident that the broad 
ligaments must give way also, as they are firmly incarcerated in 
the part which ruptures, and the immense weight of the gravid 
organ, after it has become detached from the vagina, is such that 
the ligaments must necessarily be torn. Yet, we do not under- 
stand, from a study of Figs. 114 and 115, how an}' serious 
rupture of these ligaments could take place without the organ 
itself having first given way. 

Prognosis. The prognosis of torsion of the uterus must neces- 
sarily be grave. The probabilit}' of recovery must be based 
45 



7o6 Vetemary Obstetrics 

largely upon the duration and extent of the lesion. When a re- 
cent torsion, to the extent of ^ to J^ of a revolution, exists, it is 
ordinarily not to be regarded as serious, because it may not 
greatly imperil the life of the fetus, or render its extraction a for- 
midable matter. It may not interfere very greatly with the cir- 
culation in the uterus or with the nutrition of the uterus and 
fetus. When, however, the torsion becomes complete, as in Fig. 
1 1 6, or there is almost a complete turn upon its long axis, the 
circulation of the organ is at once seriously interrupted. Unless 
prompt relief is afforded, the fetus must perish, and almost cer- 
tainly undergo decomposition with all its consequences, and the 
uterus must become seriously diseased. If the twist proceeds a 
step further, a rupture of the uterus results, which must almost 
inevitably lead to the death of the animal ; or should she survive, 
her value is usually destroyed because of the very slow, uncertain, 
and imperfect recovery, by the sloughing of the fetus through 
the abdominal walls or into the alimentary canal. 

The prognosis must therefore always be very cautiously made. 

1. The torsion may be reducible or irreducible. 

2. The fetus may be alive, or dead and emphysematous, ac- 
cording to the duration and extent of the torsion. 

3. The putrid decomposition of the fetus and the serious dis- 
turbances in the circulation may have led to uterine paralysis, 
inflammation or gangrene from which it is impossible for the 
animal to recover. 

4. The uterus may have suffered a fatal transverse rupture, 
which may not reveal itself until after the torsion has been 
reduced and the fetus extracted. 

Treatment. The handling of torsion of the uterus must be 
based upon the extent and duration of the condition and the 
character of the pathologic changes which have occurred. 

I. In slight torsion, where the uterus has not made a complete 
revolution upon its long axis, it may be possible to advance the 
hand through the vagina and cervical canal into the uterus, 
rupture the fetal membranes, seize the presenting limbs, and, 
by exerting force upon the fetus itself, cause the uterus to 
turn back to its normal position. In such a case the force 
is to be exerted in the direction opposite to the twist, 
turning the organ back to its original position. If the tor- 
sion has taken place to the right, the force, exerted indirectly 



Torsio7i of the Uterics "jo"] 

upon the uterus through the fetus, should be to the left. If the 
birth canal is sufficiently open to permit the feet to pass through 
and beyond the vulva, the correction of the position of the uterus 
is rendered much more simple, because greater power is given to 
effect rotation of the fetal body by grasping the limbs. Having 
flexed the foot at the fetlock, the pastern may be used as a lever 
to exert power. Various machines and appliances have been 
suggested to aid the operator in these cases, but, as a general 
rule, where the torsion is so slight its correction constitutes a 
rather simple procedure, and not much equipment is necessary 
for the purpose. In correcting this slight torsion, the animal 
should be in the standing position, if practicable, and with the 
hind-feet much higher than the fore-feet. We have not observed 
such slight torsion though it has been reported by others. 

When the torsion has advanced to such a degree that the hand 
cannot be inserted into the uterine cavity, it is impossible to turn 
the uterus by the application of force to the vagina. 

2. In severe torsion we may attempt either to turn the uterus 
within the abdomen of the patient or to turn the body of the 
patient and keep the uterus fixed. 

The method most frequently employed for bringing about the 
reduction of the torsion is that of turning or rolling the patient. 
The operation is best performed in the open field if weather and 
other conditions permit. Otherwise a commodious room is se- 
lected. The patient is to be cast with her hind parts elevated, so 
that the uterus may tend to drop away from the pelvis and hang 
attached by the vagina, much like a bag freely suspended from a 
fixed support. If the torsion is to the right, the patient should be 
cast upon the right side. The two forefeet should be firmly 
bound to each other and the two hind feet to each other. The 
forefeet should not be attached to the hind feet, because this 
would exert compression upon the abdomen, which would in- 
terfere with the rotation of the uterus upon its long axis, and 
consequently with the replacement of the organ. 

The operator should be careful to keep the posterior parts of the 
patient well elevated. He should kneel or lie behind the patient 
and insert his hand as far as possible, to hold the vagina or uterus 
as firmly as may be and also to determine the result of the oper- 
ation of rolling. The operation proceeds upon the assumption 
that, in rolling the body of the animal, the gravid uterus shall 



7o8 Veterinary Obstetrics 

remain static, and consequentlj' the normal relationship shall be 
restored by the patient's body revolving around the gravid uterus 
in the same direction in which the latter had previously turned. 
The operator remains in the position named, and assistants turn 
the animal upon her right side, thence upon her back and over 
onto her left side. Folding the feet beneath the patient's body, 
she is rolled up on her chest, over onto her right side, and the 
rolling continued as before. 

In discussing the cause of torsion, we suggested that the acci- 
dent probably results from a very sudden slip or turn of the ani- 
mal. In attempting to overcome the displacement of the organ, 
it may be advisable to imitate those conditions which we assume 
to have caused the displacement. Consequently, the rolling 
process, at a critical point, should be more or less sudden, in the 
hope that the body of the patient, by being moved quickly, does 
not cause the gravid uterus to move with it, but leaves it stand- 
ing still. To this end, then, when the rolling process is begun 
it may be done rather quickly, in order, if possible, to bring about 
the revolution of the body of the mother, without having the 
gravid uterus follow its motion. 

3. Others favor a modified rolling process by causing a partial 
revolution of the bod}' of the mother with an attempt to turn the 
gravid uterus in the opposite direction or to hold it from turning 
with the maternal body by means of external force applied to the 
fetus through the abdominal walls. The patient is turned slowly 
and gentlj' upon her back, while the operator or an assistant 
identifies the fetus by palpating the abdominal floor. If the 
torsion is to the right, the operator pushes against the fetus from 
the right to the left and attempts to cause the gravid organ to 
revolve toward the left, or at least to aid materially in holding 
and preventing it from rotating to the right as the body of the 
patient is suddenly brought down on her left side. 

This plan of operating is based upon the assumption that, 
when an animal suffering from uterine torsion is slowly and care- 
fully rolled over, the gravid uterus revolves to the same degree, 
but that an abrupt roll of the maternal body may change the 
relations of the-gravid organ. This influence can be aided by 
external manipulation. 

Assuming that the operation has been successful, when the cow 
has been turned completely to her left side the ropes are removed 



Torsion of the Uterus 709 

and she is allowed to stand. If the operation has been successful, 
the spiral folds of the vagina have disappeared, the hand can be 
advanced without difficulty to the os uteri, and, if the cervical 
canal is dilated, the hand may be passed on into the uterine 
cavity and the fetus grasped. 

It is highly important, in this operation, that the veterinarian 
should constantly keep, or frequently insert his hand into the 
vagina in order to determine the progress which is being made. 
Sometimes the operator becomes confused in reference to the di- 
rection of the twist, and consequentl}' in reference to the direc- 
tion in which the animal should be rolled. If his hand is intro- 
duced into the birth canal and the rolling process is begun in the 
wrong direction, he at once recognizes the fact by the increased 
pressure upon his hand as the twist becomes aggravated. If the 
turning is in the right direction, and the torsion is reducible, the 
vagina becomes more open and commodious, and the hand can 
be advanced further into it. 

In some instances the torsion is not promptly reduced, al- 
though it may eventually be accomplished by perseverance, so 
that, if turning the animal once does not completely accomplish 
the object, we should not despair, but should resort to several 
turns and watch closely the result. 

4. When the rolling process, or the partial rolling with external 
manipulation, fails to bring about a reduction of the torsion, it 
has been recommended to perform laparotomy, reach into the 
abdominal cavity with the hand, grasp the gravid uterus, and 
reduce the torsion by acting directly upon the organ. In the 
cow it would be preferable to operate upon the standing animal, 
making the incision somewhat high in the right flank. If the 
torsion is to the right, the operator reaches down between the 
right abdominal wall and the gravid uterus ; inserting the hand 
as far as possible alongside and beneath the organ, lifts up- 
ward ; and, drawing somewhat to the right, attempts to cause it 
to revolve to the left. If the twist is to the left, the operator 
passes his hand over the top of the organ to the left side, and 
downward as far as possible, and, grasping some projecting por- 
tion, draws the organ upward and to the right. How often this 
process succeeds, where rolling or external palpation fails, we 
are unable to determine. Probably not often. The gravid 



710 Veterinary Obstetrics 

uterus is so voluminous and heavy, its exterior so even and 
smooth, and it is so closely imprisoned in the abdomen that 
grasping the organ with the hand and exerting efl&cient force is 
not so easy. The force must be largely exerted by placing the 
palm of the hand at a favorable point and pressing against the 
uterine walls in an advantageous direction to induce rotation. 
We have attempted the operation twice after rolling had failed, 
each time without result. 

When the torsion has been reduced by one of the foregoing 
plans, the question of delivery arises. If the torsion has occurred 
earl J' in pregnancy, and has been promptly discovered and rem- 
edied, it may not be advisable to encourage the immediate expul- 
sion of the fetus. Cases have been recorded in the cow, six to 
seven months pregnant, in which the torsion has been reduced, 
the pregnancy continued to its normal close, and a living calf 
born. These constitute verj^ exceptional instances. In many 
cases the torsion is not discovered at this period. 

Torsion is liable to occur at any time during the last third of 
gestation, and consequently, when the veterinarian is called to 
attend a pregnant animal during this period, and finds it suffer- 
ing from some disease, the character of which is not very clear 
upon external examination, he should not fail to investigate 
carefuUjf the condition of the gravid uterus, in the course of 
which examination he would naturallj' discover uterine torsion 
if it existed. 

When uterine torsion has been reduced, and has not caused path- 
ologic changes which have destroyed the functions of the uterus, 
labor generalljr begins very shortly afterward, and the fetus is ex- 
pelled. De Bruin and others recommend that we should as a 
rule leave the expulsion of the fetus to the natural forces of the 
mother, unless there are conditions present which suggest other- 
wise. If the cervical canal is not yet dilated, time should be 
allowed for this to occur normally. If the canal is dilated, it is 
usually observed that the fetus is quite promptly expelled, so 
that very little assistance, if any, is required. If it seems ad- 
visable to apply traction to the fetus, it should be done very 
cautiously, and abundant time should be given for the passage of 
the fetus through the birth canal. It is needless to state that, if 
the fetus presents abnormally, it should be adjusted. 



Torsion of the Uterus 711 

Before applying traction or carrying out other manipulations, 
after the organ has been replaced, we would advise the practitioner 
to search carefully in every part for transverse rupture of the 
cervix uteri or other important injuries, because, if such rupture 
has occurred during the torsion of the organ, it should be discov- 
ered promptly and the owner of the animal advised of the condi- 
tions, that he may relieve the veterinarian from any responsibil- 
ity which might rest upon him otherwise because of the later 
discovery of the condition. 

De Bruin aptly remarks that, in these cases, examination should 
be made before any operation is begun, with a view to deter- 
mining whether the case has already been handled by empirics or 
others, and in this way the outcome rendered more doubtful. 

Torsion of the uterus is frequently irreducible. In one 
case which we attended, the torsion had apparently existed for 
about two weeks, and the spiral folds of the cervix and vagina 
had become so firmly adherent to each other, Figs. 1 17 and 118, 
that the organ could not very well have been untwisted. 

Reduction was also made virtually impossible by the fact that 
the fetus was dead, emphysematous, and swollen to thrice its 
normal volume, and so great a volume of fluid had transuded 
into the uterine cavity as to increase the weight and volume of 
the organ to such a degree that there was neither room within the 
abdominal cavity to turn the organ nor power enough in the arms 
of a man to bring about its rotation. In addition, the uterus was 
so firmly adherent over its entire surface to the surrounding or- 
gans and abdominal walls that a replacement of it was impossi- 
ble, until it had first been dissected loose. 

In another of our cases, the organ was free from adhesions, 
the torsion had existed for some days, the emphysematous 
fetus and the transuded liquid had so thoroughly distended the 
uterus, and its walls were so voluminous, that it occupied vir- 
tually the whole abdominal cavity, and there was simply a want 
of room in which to turn the organ, and its weight was entirely 
too great for a man to lift. 

In those cases where the torsion has ended in a complete trans- 
verse rupture through the cervix or vagina, reduction is evi- 
dently impossible. When gangrene of the uterus has occurred,, 
reduction, if possible, is useless. 

When torsion is irreducible, there is virtually no hope for 



712 Veterhiary Obstetrics 

the life of the fetus, because in almost, if not all cases, it has 
perished before the condition has been realized, and consequently 
its life or value is excluded from consideration. 

If irreducible torsion has occurred early in pregnane)', it is 
possible, according to some writers, that infection may not reach 
the uterus and its contents, and that as a result the fetus may 
undergo mummification, in which instance the animal, if a meat- 
producing one, may be fatted for the butcher and disposed of in 
that way. 

In some instances, the fetus may undergo putrid decomposi- 
tion and slough out through the abdominal floor or into the di- 
gestive tract, and by a long and tedious process the animal may 
eventually recover. But the economic loss is well-nigh total, be- 
cause of the total loss of breeding power and the long time re- 
quired for recovery. 

5. Caesarian Section. The chief hope in cases of irreduci- 
ble torsion is Caesarian section, and the value of this should al- 
ways be judiciously considered. Usually there can be no hope 
for the life of the fetus, and the fertility of the mother is at an 
end. We have left for consideration the question of the eco- 
nomic value of the animal for meat, wool or labor ; or the sen- 
timental value of the saving of the life of the animal. Whether 
we operate or not should be determined after considering all these 
factors. The operation has already been described on page 663. 

Should gastro-hysterotomy be performed in torsion of the 
uterus, it is to be remembered that the evacuated uterus must 
not be completely closed and returned into the peritoneal cavity 
unless the torsion has been reduced. If the torsion remains and 
the uterine incision is closed, the escape of uterine excretions 
is barred. The margins of the uterine incision may be securely 
sutured to the margins of the abdominal incision, thus providing 
an avenue for the escape of uterine discharges externally. 
Usually it would be preferable to amputate the diseased cornua 
and body of the organ, and secure the cervix to the margins of 
the abdominal incision. In other cases the entire organ may be 
amputated, with a portion of the vagina, the latter ligated and 
returned into the pelvic cavity, and the abdominal incision com- 
pletely closed. 

In the smaller animals, where one of the cornua undergoes 
torsion, reduction is practically out of the question, and only 
gastro-hysterotomy remains. 



FETAL DYSTOKIA. 

In veterinary obstetrics, abnormalities in the form or attitude 
of the fetus furnish by far the most numerous instances of dys- 
tokia. The ways in which the fetus may serve as an obstacle to 
its own expulsion from the uterus are exceedingly varied, and 
may be dependent upou something abnormal in the fetus itself, 
due to arrest in development, to disease during its intra-uterine 
life, or to its death and decomposition ; or it may be due to 
some deviation in its attitude when approaching the birth canal, 
which may render its passage difficult or impossible. 

It is convenient for the proper study of these difficulties that 
they be divided into groups dependent somewhat upon their 
character. These may be synoptically outlined as follows : 



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A. DEVELOPMENT OF THE FETUS IN AN ABNORMAL 
POSITION IN THE UTERUS. 
BICORNUAL PREGNANCY OR TRANSVERSE DE- 
VELOPMENT OF THE FETUS. 

The uteri of domestic animals are so definite and characteristic 
in their form that they usually admit of the development of the 
fetus in but one position, in which the long axes of the uterine 
cornu and the fetus must be parallel. In uniparous animals the 
two cornua usual!}' leave the rather ample body at an acute 
angle, and the single fetus is almost inevitably developed in a 
longitudinal position, somewhat equally in one of the cornua and 
in the uterine body. 

In multiparous animals the inconspicuous uterine body is usu- 
ally empty, and the fetuses are-developed almost wholly in the 
extensive cornu, in a longitudinal position. 

In the mare, however, the form of the uterus is such that it 
may lead, as we have already stated on pages 28 and 379, to a 
bicornual or transverse development of the fetus. 

The earliest account we have found of this abnormality is by 
Pauli, who, in Gurlt and Hertwig's Mag., 1842, Vol. 8, p. 196, 
records attending in 1837, with two colleagues, a mare which 
they could not deliver. Autopsy revealed a transverse fetus, 
dorsal presentation, head, neck and anterior limbs in right 
horn, hind feet in left horn, abdomen and chest occupying the 
uterine body. 

So far as we are aware, definite attention was first drawn to 
this anomaly by us, in an article entitled ' ' Transverse Develop- 
ment of the Fetus in the Uterus of the Mare ' ' in the American 
Veterinary Review, Vol. 13, page 298. Later occurred a de- 
scription of apparently the same anomaly by Anton Tapken, 
Ofl&cial Veterinarian in Varel, in the Monatshefte fiir Praktische 
Tierheilkunde, Vol. 18, page 148, of which a translation by us 
appeared, with added comments, in the Veterinary Journal, Vol. 
XLIII, page 148. 

Bicornual development of the fetus is made possible in the 

mare because of the unique direction in which the two uterine 

cornua are given off from its body. Instead of leaving the 

uterus at an acute angle, as in ruminants and carnivora, they 

716 



Bicornual Pregnancy 717 

depart from the body at right angles, or slightly recurved so as 
to give the entire organ, consisting of the body and coruua, a 
crucial form. It thus becomes possible for the fetus to develop 
in such a position that the long axis of its body corresponds to 
the combined long axes of the two uterine cornua ; that is, the 
fetus develops partly in each of the two cornua, with its body 
crossing the uterine body at its anterior extremity, so that the 
fetus fundamentally occupies a position with its long axis trans- 
verse to that of the mare. 

How often this may occur in the mare, we do not know. In 
our contribution above quoted, we recorded four cases, to which 
we may add the four case reports of Tapken and one of Pauli. 

It is a well known fact, to all who have had extensive obstetric 
practice in mares, that it is not rare for the foal to present trans- 
versely. This is in sharp contrast to cattle obstetrics, where 
transver.se presentation is very rare. Among these presentations, 
except those cases which we now have definitely under con- 
sideration, it is impossible to determine how many of them may 
have developed transversely, and consequently at the time of 
birth presented transversely. While veterinary obstetrists may 
deny the posssibility of bicornual development, our cases, fully 
verified by post mortem examination, show that it actually occurs, 
and not very infrequently. The established facts do not forbid 
our assuming that some of the other fetuses which present trans- 
versely ma\' have been developed in the transverse position. 

In the cases now under consideration, the embrj-o apparently 
forms in each case in the transverse presentation, with its ventral 
surface presenting toward the os uteri, and later revolves upon 
its long axis, so that it finally rests in a dorsal tran.sverse presen- 
tation instead. 

In its earlier stages, the embryo curves very markedly ven- 
tralwards, and this ventral curvature continues to a consider- 
able degree throughout gestation. Since the cornua of the uterus 
leave the body at right angles or slightly recurved, the embryo 
may well develop with either its dorsal or ventral surface facing 
the OS uteri, although, so far as investigations upon this point 
carry us, only those cases have been recognized as bicornual 
development which have begun their development with their 
ventral surface presenting toward the pelvis. 



yiS Veterinary Obstetrics 

If the embryo commences to form in the uterine cornua, with 
its ventral surface directed toward the os uteri, and the fetus 
curves ventrally, it would naturally follow that, as it attains 
weight, the central portion of its body would tend to drop 
downward, while its two extremities would point upward toward 
the oviducts. Later the fetus would tend to descend until the 
convex dorsal surface would come in contact with the abdominal 
floor and thereb}' assume an unstable position. Since the anatom- 
ical conditions prevent its revolving upon its long axis in the di- 
rection of the pelvis, it may acquire stability only by its ex- 
tremities passing forward and downward to come to rest upon 
the abdominal floor. In accomplishing this movement, the fetus 
revolves upon its long axis ; and in doing so its dorsal surface 
turns toward the birth canal, pushing the uterine floor back- 
ward beneath the 'vaginal floor, and stretching the roof of the 
vagina forward. In this transverse position, the fetus must 
necessarily drop well forward and remain wholly in front of the 
pubis, thus stretching and elongating the vagina to a remarkable 
degree. We have attempted to indicate this change in the 
position of the fetus in Figs. 120 and 121. 

Symptoms. This anomaly in development naturally passes 
unobserved during the entire period of gestation, and is not dis- 
covered until an examination is made in order to determine the 
cause of dystokia. The symptoms are then unique and diagnos- 
tic. Before the obstetrist is called, the os uteri has become 
dilated, the water-bag has appeared and ruptured, and probably 
some of the fetal membranes lie in the vagina or protrude from 
the vulva. The labor pains are weak in character. The fact 
that no portion of the fetus, or at least no considerable portion 
of it, can usually be forced into the vagina, tends to inhibit any 
well marked expulsive efforts. Such would necessarily prove 
futile, and dangerous to the integrity of the uterus. 

When the obstetrist inserts his hand, he is first struck by the 
extremely elongated and narrowed vaginal passage, which is 
nearly twice its ordinary length, although very much decreased 
in its transverse diameter. No os uteri or cervix is distinguish- 
able as such. If the obstetrist follows the roof of the vagina, 
the hand glides along it almost as far as the arm can reach ; or 
perhaps he cannot reach the anterior end of the roof, where it 



Bicornual Pregnancy 



719 



finally turns down in a gradual curve, without any recognizable 
line of demarcation between it and the uterus. 

If he follows the floor of the vagina and palpates carefully as 
his hand passes along, he will discover to his astonishment a 
hard body lying beneath it, which upon careful manipulation 
he may recognize as portions of the fetus, lying directly against 
the vaginal floor, and impressing him very strongly at first with 
the idea of extra-uterine pregnancy. If he will follow the 
uterine floor further, to the extent of nearly the entire length of 
his arm, his hand suddenly passes downward into the uterine 
cavity, and he finds that the floor which he has been following 
bends abruptly backward to constitute the roof of the uterus, 
immediately beneath which the fetus lies transversely with its 
dorsal surface presenting toward the pelvic inlet. 



Fig. 120. Transverse 
OR Bicornual Devel- 
opment OF THE Fetus 

IN THE M.A.RE. 

V, Vagina. U, Uterine 
cavity, which is later to 
blend with the vagina to 
constitute an elongated 
tube. UC, Uterine cornu. 




'Wm^' 



720 



Veterinary Obstetrics 



In some cases the obstetrist may find one or more feet project- 
ing from the uterus into the vagina, which may be readily 
reached and grasped. In a large proportion of cases, however, 
no portion of the fetus projects into the vagina, and before the 
operator can bring his hand into immediate contact with any por- 
tion of the fetus he must reach far forward and then, bending 
the hand downward and backward, touch the ventral portion of 
the fetus or some of the extremities which are folded along it. 
In order to accomplish this, he reaches clear over the body of 
the fetus, passes beyond its ventral line and then, after passing 
the point of version where the floor of the vagina ends, turns the 
hand downward, and more or less backward, into the uterine 
cavity. These peculiarities serve to differentiate this condition 
from any other known in veterinary obstetrics. 




i. 121. BicoRNUAL Pregnancy. Second stage, the fetus having made 
one-half revolution on its long axis. (Schematic). 
V, Elongated vagina and uterine body. 
UF, t'loor of uterine cornua, now become the roof. 
UR, Roof of uterine cornua, now become anterior wall. 
BL, Broad ligament. 



Bicornual Pregnancy 721 

Prognosis. The prognosis in this condition is always highly 
unfavorable. We have no record of any case in which the life 
of either mother or fetus has been saved. Tapken says, "De- 
liver}^ is always difficult. If no part of the fetus can be reached, 
delivery is evidently impossible. In each of the four cases which 
I append, the result was fatal for both mother and foal, and such 
was also the result in another case, which, owing to oversight, 
was not included in the foregoing table. In the latter case of 
dystokia, two experienced colleagues had already tried in vain to 
deliver the mare before I had been called. It was barely possible 
to touch the metacarpus of one leg with the finger tips, when 
the arm had been introduced completely to the shoulder." The 
case of Pauli also ended fatally for both mare and foal, despite 
the efforts of three veterinarians. 

In our own experience we have been equally unsuccessful, and 
have encountered great and even insurmountable difficulties in 
delivery. In one of our cases the mare survived the operation 
some days, but finally succumbed to metritis. In that one case 
it would seem possible that, had we had a better understanding 
of the conditions and given closer attention afterward, she might 
have- been saved. We would not, therefore, advise the veterin- 
ary obstetrist to refrain from attempting to deliver a mare in this 
condition. However, in undertaking it, it would be well in our 
judgment to advise the owner of the highly unfavorable prog- 
nosis of the case, so that he may be forewarned of the probable 
outcome. 

Method of Handling. Each case must be dealt with, in 
detail, according to circumstances. In general, it is well to se- 
cure any of the extremities which may lie within reach and cord 
them, so that force may be exerted upon them at any time that, 
it may become desirable. If all four feet can be reached, it is 
usually advisable to amputate the two anterior limbs, either 
subcutaneously or at the humero-radial articulation, and then 
attempt to convert the presentation into a posterior one by 
drawing carefully upon the hind legs. 

The position of the animal is important. Fig. 121 suggests 

that, if we turn the mare upon her back, the version of the uterus 

will tend to disappear and the fetus will be brought nearer to the 

operator, so that parts which previously had not been in reach 

46 



722 Veterinary Obstetrics 

may now be grasped. Placing the mare upon her back also re- 
laxes the projecting floor of the vagina and, by tending to over- 
come the version of the organ, renders traction upon the fetus less 
dangerous to the floor of the vagina and the roof of the uterus. 

Various positions of the mare may be tried in an effort to 
overcome the diSiculty. It must be remembered that it is ex- 
ceedingly exhausting to the mare to remain for a long period of 
time upon her back, and this position should not be continued 
be3'ond the absolute necessities of the case. If the work can 
be done nearly as well with her standing upon her feet, this 
position should be preferred until the critical time arrives for 
extracting the fetus by force, when we believe it would be best 
in all cases to turn the mare upon her back for this brief period 
and thereby relieve the vaginal floor and uterine roof. 

The position of the fetus and its relation to the uterus render 
most forms of embryotomy exceedingly' difficult or impossible. 
In our experience, we have been limited to the possibility of the 
amputation of the limbs. The decrease in the size of the fetus, 
were we able to bring about embryotomy, especially evisceration, 
would favor its delivery. 

After the extraction of the fetus, if the obstetrist has been so 
fortunate as to accomplish this without fatally injuring the 
uterus, unusual care should be taken to guard against sepsis. 
Fig. 121 shows that the form of the uterine cavity is extremely 
unfavorable for adequate drainage, and suggests that this be over- 
come as far as possible by careful and repeated irrigation of the 
uterus and siphoning out of the contents. 

In view of the fact that we have been unable to save the life 
of either mare or foal in any case, and, so far as we have been 
able to determine from recorded cases, no mare or foal has been 
saved by other practitioners, it would seem to us that the 
veterinary obstetrist is fully warranted in earlj' resorting to 
gastro-hysterotomy in a way to possibly save the life of his 
patient. While we have not attempted this operation in the 
mare, we believe that it offers the greatest hope for success in 
these cases. Evidently there is nothing to lose. In one of my 
cases, as in one of those recorded by Tapken, deliver}' through 
the birth canal was wholly impossible, and under such conditions 
clearly the only plan remaining is hj'Sterotomy. 

Presumably there is never an opportunity to save the life of 



Bicornual Pregnancy 723 

the foal ; it is ordinarily dead before the obstetrist is called. 
We have outlined the technic of hysterotomy on page 663. 

The following cases illustrate the variations and difficulties to 
be overcome, and suggest, more forcibly than anything else well 
can, the seriousness of the anomaly. Cases i to 3 are quoted 
from the contribution by Tapken ; cases 4 to 6 are from our 
personal experience. 

1. An old mare, which had already foaled regularly a number of times, 
showed symptoms of colic in the evening after the normal duration of preg- 
nancy. Later, mild labor pains appeared and some of the fetal waters were 
expelled. Upon examination, at 8:30 A. M., the mare was comfortable, ate 
some, no labor pains recognizable. At times there was a discharge of fetal 
fluids. The cervix uteri was dilated. Portions of the ruptured chorion ex- 
tended into the vagina. The uterine walls were stretched and thrown into 
folds similar to torsion of the uterus, but nearer to the body of the uterus- 
The fetus could barely be reached with the finger tips, after the arm had been 
introduced up to the shoulder. During the e.xploration there were only 
feeble labor pains. 

An attempt to modify the position of the uterus, by rolling the mare, 
failed. While in the recumbent position, however, strong labor pains ap- 
peared. As a consequence of these violent pains, the tightly stretched uter- 
ine wall was pressed into the pelvis to such an extent as to threaten rupture. 
The neck of the bladder was also dilated to such a degree that four fingers 
could be introduced into it. During the violent pains, the urinary bladder 
was from time to time forced out into the vulva, where it was visible as a 
whitish mass about the size of a man's fist. 

A second veterinarian was called in consultation. At 4 P. M. the further 
handling of the case was undertaken by T., in company with his colleague 
K. After a prolonged effort, the lower end of the tibia was grasped, and a 
cord attached above the hock. 

By means of a vigorous pull by four persons, the tarsus was brought to 
the pelvic inlet, and the tendo-Achilles divided, partly with a knife and 
partly with shears. Both arms were inserted in the genital canal, and 
finally the leg was drawn out so far that it could be amputated at the hock. 
The second leg could not be grasped. Traction was applied to the tibia of 
the amputated leg, and, with the force of six persons, the skin and muscles 
torn asunder without any incisions having been made, and the leg tore away 
at the hip joint and was drawn out. The other tarsus could then be grasped, 
and was handled in the same way. Upon the application of powerful traction 
by six persons, the fetus was extracted. It was large, but normally formed. 

In the uterus, near the neck, there existed a perforation. The mare died 
a few hours later. 

2. An eight-year-old mare, which had repeatedly foaled in a normal 
manner, showed, after eleven months pregnancy, weak labor pains and un- 
rest for a period of two and one-half hours. An examination revealed one 
fore-leg, presenting in the normal position and direction, in the pelvis. Be- 



724 Veterinary Obstetrics 

neath the advanced limb, the uterus and vagina formed a projection, under 
which one could distinguish parts of the fetus, especially the head. These 
parts were time and again forced to the middle of the pelvic cavity during 
the labor pains. Beneath the presented foreleg one could feel, through the 
uterine wall, other parts of the foal, which later were found to be the second 
anterior limb flexed at the carpus. 

After mounting a stool, so that the arm could be inserted as far as 
possible, he succeeded in reaching the point of flexure of the uterus. It was 
not possible to grasp any other part of the fetus. The anterior limb was 
corded and drawn out by three persons, until the forearm was visible. The 
other anterior limb was then released from the folds in the uterus and 
brought into the genital canal, but it could not be extended. In order to 
secure room, the extended limb was detached. The division of the skin 
was incomplete, and could only be extended to the elbow joint. As a re- 
sult of this, it required the combined power of six or seven persons to draw 
the limb away. 

The head, which was clearly recognizable at the beginning of the opera- 
tion, became displaced in such a way that it could no longer be reached. 
There remained, consequently, no other recourse than a forcible extraction 
of the fetus, which was accomplished by the traction of six or seven persons. 

The mare lay exhausted and listless. After half an hour the pulse was 
60, strong and regular, which indicated that no great amount of internal 
hemorrhage was occuring. A small amount of blood flowed from the vulva. 
By a manual exploration of the uterus, no labor pains were induced. 
After three and one-half hours the mare arose, staggered somewhat at first, 
but soon partook of food. In the following days the appetite was fairly 
good, then failed. 

Four days later the mare was again examined. The pulse was 70, the 
appetite poor, and now and then there were expulsive efforts. Upon ex- 
amination of the parts, there was found a great gaping rent in the superior 
wall of the uterus, so that it was easy to introduce the hand directly into 
the peritoneal cavity. The animal died on the sixth day. The autopsy 
revealed a rent in the uterus about 25 cm. long, also diffuse peritonitis. 

3. A young mare, at full term, had shown labor pains for several hours. 
Fetal waters had appeared. Upon inserting the hand as far as possible, 
only fetal membranes and the uterine wall could be felt ; through these 
walls, however, in the reflexed uterus, parts of the fetus could be recognized. 
An empiric, with the consent of the owner, had made an examination and 
had torn through the wall of the uterus, which he had mistaken for the 
fetal membranes. The mare was destroyed. 

4. In 1887 the writer was called to attend an imported Percheron mare, 
because the keeper believed her to be in labor, although in some way the 
symptoms appeared to him unusual. 

Upon examination no expulsive efforts could be obser\'ed, and when 
manual exploration of the vagina was made there was marked narrowness 
of the passage at the usual location of the os uteri, which was mistaken for 
it. Lying beneath the vagina, a fetus was felt, apparently with • all its 
membranes intact. Non-interference, with close watching, was advised. 



Bicornual Pregnaticy 725 

The mare continued fairly well and quiet for about 48 hours, when we 
were recalled and, upon making a second examination, found the fetal mem- 
branes protruding from the vulva. Upon careful examination it was 
found that the part, which was previously supposed to be the os uteri, was 
merely the narrow vagina, beneath which the fetus lay. The presence of 
the membranes permitted us to follow them along their course until the 
opening into the uterus was reached, when it was found that nothing resem- 
bling the normal os uteri was present. 

The vagina was extremely long and narrow. Far to the anterior, barely 
within reach, the canal opened abruptly downwards and backwards into 
the uterus. Posterior to this opening, and beneath the vagina, lay the 
body of the foal, in a transverse position, readily felt through the vaginal 
and uterine walls. Though beyond reach through the os uteri so long as 
the mare was standing, when she was recumbent the hind limbs could with 
difficulty be reached. 

After patient and exhausting work, the hind legs were secured at the 
tarsus by means of cords, but it was impossible to bring them into the 
passage until the feet were amputated through the lower tarsal articulation. 
We then had the two hocks presenting with the ossa calces directed up- 
wards, while beneath the vagina could still be felt the main volume of the 
fetus. Firm traction applied to the hind limbs finally brought the fetus into 
a posterior presentation, and accomplished its extraction after about five 
hours of very trying labor. 

Examination immediately after deliver)' revealed an enormous rupture of 
the uterus and inferior wall of the vagina. The animal was destroyed, but 
no autopsy made. 

5. A large French draft mare in excellent condition, which had pre- 
viously bred successfully. The fetal membranes were found protruding, but 
no well-marked labor pains. Exploration revealed an exceedingly long, 
narrow vagina, which, at its anterior extremity, barely within reach, opened 
abruptly downwards and backwards. The usual conformation of the os 
uteri was wanting. While the mare was standing, no portion of the fetus 
could be touched by passing the hand into the uterus. There seemed to be 
a great cavity to the right and left and posteriorly. By following the supe- 
rior walls of the vagina up to the uterus, we found this bent abruptly down- 
ward to become the anterior wall, which could be followed as far as the 
hand could reach without coming in contact with any portion of the foal. 
Posterior to this opening and beneath the floor of the vagina, the fetus could 
be plainly felt. By passing the hand through the uterine opening, 
drawing its posterior margin firmly backwards, and then reaching down- 
ward and backward as far as possible, a portion of the fetus could be barely 
touched, but not grasped. 

After casting the mare and placing her upon her back, one hock was se- 
cured, corded, and with great difficulty brought into the passage. Then one 
anterior limb was secured and amputated. Later the other hind leg was 
secured, and with strong traction the fetus was brought away after eight 
hours of exhausting labor. The mare succumbed 24 hours later, and no 
autopsy was made. 

5. The writer was called in consultation, in case of dystokia in a large 



726 Veterinary Obstetrics 

draft mare whicli had bred repeatedly before without difficulty. The vagina 
was abuormally elongated and narrow, and its anterior end opened abruptly 
downward and backward without resemblance to the usual os uteri. The 
fetus could be plainly felt through the floor of the vagina, posterior to the 
opening into the uterus. It lay with its back against the pubis of the mare. 
By passing the hand through the opening into the uterus, and then down- 
wards and backwards, the elbow of one fore-leg could be touched with 
difficulty. After long and arduous labor this one limb was secured and 
brought into the passage, but we were wholly unable to secure any other 
limbs or parts of the foal, either by raising the abdomen with a sling or by 
casting the mare and turning her upon her back. Though my colleague 
was an experienced obstetrist and a large and powerful man with very long 
arms, it was impossible for either of us to secure other parts of the fetus. 
The one limb which we had succeeded in cording was in such a position, in 
relation to the uterus and vagina, that traction could not be applied with any 
safety or efficiency. After a long and fruitless effort, the mare was destroyed, 
and a post-mortem examination immediately made. 

The foal, very large and well matured in every respect was lying upon 
its right side with its dorsum against the pubis of the mare. The head was 
located in the right uterine cornu, and the hind legs and buttocks in the 
left. The body lav in a thoroughly transverse position across the abdominal 
cavity, posterior to the opening between the vagina and uterus. One fore- 
leg was flexed at the carpus, and the other, which we had secured, was 
drawn backward over the neck of the fetus, into the vagina. The two 
cornua were developed equally, and their long axes were perpendicular to 
that of the mare. The vagina, because of the transverse position of the 
fetus and the peculiar version of the uterus, was much elongated and 
narrow. The opening from the vagina into the uterus was abruptly down- 
wards, thf; superior vaginal wall suddenly losing itself by turning abruptly 
downwards to become the anterior uterine wall. Thus that portion of the 
uterus which had originally constituted the roof or superior wall had now 
become its anterior wall. The inferior wall of the vagina, or floor, 
terminated anteriorly abruptly, in a thin margin ; what had previously 
been the Jtoor of the uterus was turned abruptly backwards against the 
vagina, thus becoming the superior uterine wall. 

******* 
While the biconiual development of the fetus seems to be 
naturally limited almost whoUj' to the mare, because of the 
peculiar conformation of her uterus, rare exceptions are recorded. 
Cuille, Revue Vet. 1905, records a case of bicornual pregnancy 
in the bitch, which caused insurmountable dystokia. The 
autopsy showed a fetus, lying with its head and fore legs in the 
right horn and its croup and hind legs in the left. In another 
case of dystokia, in the bitch, C. extracted the fetus by traction 
on one fore foot, and believed that this also was a case of bi- 
cornual pregnancy. 



B. ABNORMALITIES IN THE DEVELOPMENT, 
OR DISEASES OF THE FETUS. 

a. Excess of Volume of the Fetus. 

Excess in the volume of the fetus is a comparative term. It 
is the relation existing between the size of the fetus and the di- 
mensions of the birth canal of th emother, rather than definite 
abnormality in volume. Such comparative excess in size is not 
rare in domestic animals, and is frequently a more or less serious 
obstacle to the expulsion of the fetus. 

The causes of this comparative excess in fetal volume are 
not clear. The excess; may be confined to one part of the body, 
or may apply to the entire body. 

Prolonged gestation is sometimes believed to increase the 
volume of the fetus. In the cow and mare there are great 
variations in the duration of gestation, ranging from 30 to 90 
days or even more. During this period the fetus is presumably 
constantl}' growing, and, if carried for 30 to 60 days be^'ond the 
briefest duration of pregnancy, it would be but reasonable to ex- 
pect that it may be larger because of this longer period of intra- 
uterine development. 

Nevertheless it has not been possible to verify this suggestion 
by clinical observation. Prolonged gestation does not commonly 
result in such a growth of the fetus as to cause any serious ob- 
stacle to its delivery. It is true that those fetuses which are 
born after a comparatively short duration of gestation, prema- 
ture births, are usually very small, but they are also correspond- 
ingly immature. When they reach the average duration of 
intra-uterine development they seem to be as large as though 
carried for a much greater length of time. In one instance 
which we noted, where the duration of gestation in a mare ex- 
ceeded 12 months, the foal to which she gave birth was a pigmy 
about half the size which would naturally have been expected 
in harmony with the size of the sire and dam. 

Neuman (B. T. W., 1909, p. 702) records delivering a cow, 413 

days pregnant, of a putrid, emphysematous calf, weight 110 lbs. 

long hair, female, form of male. The impression is given 

that the large size was due to prolonged gestation. The fact 

727 



728 Veterinary Obstetrics 

that the fetus was dead and emphysematous destroys all evi- 
dence of prolonged gestation. The fetus may have perished at 
280 days. In 1908, 'Frost, instructor in the N. Y. State Veteri- 
nary College, delivered a Holstein-Fresian cow of a calf weigh- 
ing 147 lbs. The duration of pregnancy was normal, the calf 
was normal, and was alive, but died during delivery. Calves 
weighing over 100 lbs. are not rare in this breed. It is con- 
sequently unwarranted to conclude that, because a fetus is un- 
usually large, the duration of pregnancy has been excessive ; or 
that, because pregnancy is being prolonged, dystokia from ex- 
cessive volume of the fetus must occur. While rare exceptions 
may occur, according to our observations the largest fetuses are 
usually encountered in those cases where the full duration of 
what we regard as normal pregnancy has merely been reached. 

It appears, from all that we can learn of the subject from a 
clinical standpoint, that the retention of the fetus in the uterus, 
beyond the average duration of time, is not dangerous from the 
standpoint of causing dystokia by excess of volume, but rather 
that other complications may arise which may be more or less 
dangerous for the well-being of the mother and fetus. 

In multiparous animals, like the bitch and sow, it is frequent- 
ly noted that when the number of fetuses is below the average 
they tend to grow larger because of the increased nutritive 
supply, and in this way tend to cause difficult labor. 

Excessive size of the male animal, as compared with that of the 
female, has been alleged to cause an excessive size of the fetus, 
but this we have not been able to verify clinically. We have 
had occasion to observe the results of crossing small mares of 
700 to 1000 pounds with large draft stallions weighing from 1800 
to 2500 pounds, or approximately three times the weight of the 
mare. Yet we did not observe a case of dystokia, in such mares, 
attributable to excessive volume of the fetus. 

Fleming cites several authors to show that such crosses do re- 
sult in difficult labor, especially in the ewe and bitch. On the 
other hand, Saint-Cyr states, in harmony with our personal ex- 
perience, that he has repeatedly seen large Percheron stallions 
crossed with small mares, without any resulting difficulty in 
foaling, because of size. 

It appears from clinical observation that the size of the female, 
not that of the male, chiefly fixes the size of the fetus, and 



Excess of Volume of the Fetus 729 

that the variation in the size of animals because of cross-breed- 
ing occurs during extra-uterine life, and not during gestation. 

On the other hand, our observations indicate that the male in- 
fluences the form of the fetus and the comparative volume of 
certain portions of its body. This variation is noticed chiefly in 
the size of the head. It has been ob.served that the crossing of 
ewes with rams of certain breeds having larger heads may lead 
to dystokia because of the comparatively large size of the lambs' 
heads. In one instance we observed that many of the cows bred 
to a certain bull, which had a ver}' heavy head and neck, re- 
quired assistance because of the voluminous heads and necks of 
the calves. 

When the domestic cow is crossed with the buffalo or American 
bison, with his very heavy head and neck, there is very liable to 
be difficulty in giving birth to the young, becau.se of the large head 
and chest of the hybrid fetus. 

The breeding of immature females constantly tends to produce 
dystokia because of the comparatively large size of the fetus. The 
fetus itself is actually smaller as a rule than the same female would 
produce later in life, but the birth canal, and especially the pelvis 
of the very young female, is not yet developed to a degree which 
will render birth easy or practicable. It is a common experience, 
therefore, that young heifers, which give birth to calves when 
only I yiz years old or even younger, may require some degree of 
assistance in order to expel the fetus. The same is noted in 
immature sows, and to some extent in other animals. 

In one instance which we noted, the owner of a number of 
fillies allowed a stallion colt to run with them at pasture, and 
several yearlings became pregnant. Before the end of gestation 
contagious abortion broke out, so that they all aborted, and sev- 
eral of them required assistance in order to get rid of the very im- 
mature fetuses. Judging from these observations, it would seem 
probable that, had they carried their fetuses to the normal close 
of gestation, there might have been difficulty in expelling them. 

Clinical observations apparently show that the fetuses are larger 
if the mother has been well fed. But this does not seem to in- 
terfere greatly with birth, because, while the fetus is compara- 
tively larger, the expulsive powers of the mother are also greater 
and the birth as a rule is easier. If, however, an animal is very 



^.•^ 



73 o Veterinary Obstetrics 

fat, her young is not as a rule so large as the young of an animal 
which is simply well nourished. 

Diagnosis. Excessive volume of the fetus is difficult of accu- 
rate determination, prior to its entrance into the pelvic canal. 
Various means have been suggested for determining this excess 
in volume, but they are necessarily unreliable. Some have sug- 
gested an unusual size of the abdomen, but this may depend upon 
twin pregnancy, an excessive number of fetuses, or hydramnios 
or other cystic disease. In many animals we note an enormous 
abdomen as the result of the character of the food or of individual 
peculiarity. 

Along similar lines, some veterinarians have suggested that 
the excess in size may be anticipated owing to increased weight 
of the animal. 

Its final determination must occur when, with a normally di- 
lated cervix and normal genital canal, labor sets in and the ex- 
pulsive efforts are vigorous, and, although the fetus is normal 
in form and position, little or no progress is made in its expul- 
sion. If J under these conditions, the veterinarian examines the 
patient, he is enabled to judge that comparatively the size of the 
fetus is too great to pass readily through the birth canal. How- 
ever, this opinion does not depend upon any definite measure- 
ment which he is able to make of the dimensions of the pelvis. 

The principal obstacles to birth, in most of these cases, are the 
head and chest. The obstruction caused by the head is especially 
notable in the bitch and cow. In the bitch the difficulty most fre- 
quently occurs in those breeds, like the bull-dog, which have 
short muzzles and consequently present a blunt extremity to 
pass through the undilated canal. 

In the mare, the head of the foal is small and elongated and 
rarely offers any serious obstacle to birth. Generally it is only 
when the chest or croup arrives at the pelvic inlet that serious 
difficulty arises because of volume. 

We have already noted in the preceding pages that the dimen- 
sions of the chest of the foal are greater than those of the pelvis 
of the mother, and that it is only by some displacement of the 
parts, especially of the shoulders, that the chest of the foal is 
capable of passing through the birth canal. When the dimen- 
sions of the fetus are such that it is impracticable for the diminu- 
tion by displacement to be sufficiently great to permit it to 



Excess of Volume of the Fetus y^i 

pass through, we meet with a more or less serious obstacle to 
parturition. 

Prognosis. The prognosis in case of excessive volume of the 
fetus must depend largely upon the degree of excess, and still 
more upon the duration of the dystokia. 

In the mare the outlook for the foal is always bad, because the 
delivery cannot be greatly hurried with safety to the mother and 
cannot be delayed with safety to the fetus. In fact, as already 
repeatedly stated, the foal is usually dead when the obstetrist is 
called. The prospects for the mare may be said to be usually 
good, but it should be remarked that dystokia in the mare, refer- 
able to excess in the volume of a living fetus, is exceedingly 
rare and does not constitute a formidable question. 

In the cow the outlook is usually good for the mother, and if 
the excess of volume of the fetus is not too great to permit of 
delivery by forced extraction the prognosis for the calf is also 
favorable. Unfortunately, however, we have met with cases in 
the cow where embryotomy was necessary because of the excess 
of volume. 

The comparative excess in volume of the fetus in multiparous 
animals where embryotomy is possible, is in many respects more 
serious than in the larger species. In a large proportion of 
these the head of the fetus does not enter the pelvis, and conse- 
quently traction cannot be applied because the head cannot be 
secured. As a result, the veterinarian is forced to resort to Cae- 
sarian section in order to bring about delivery, and this operation, 
while not necessarily fatal to either mother or fetus, must con- 
stantly be considered as grave. 

Handling, i. Forced extraction of the fetus should be car- 
ried out in all those cases where, in the judgment of the veterin- 
arian, it can be accomplished with reasonable safety to the mother. 
Prior to its application, it should be determined that the fetus is 
in a correct position, after which the genital canal should be 
thoroughly lubricated with warm lysol solution or fat, and the 
traction then applied. In the mare and cow, and to a less extent 
in the ewe and goat, the traction may be exerted by means of 
cords applied to the presenting parts, as described on page 586. 

In the sow, bitch and cat, traction is usually best applied by 
means of forceps such as Fig. 93 on page 585, or the obstetric 
noose such as f and g, Fig. 91, page 578. Very largely, forced 



732 , Veterinary Obstetrics 

extraction is not possible or desirable in small animals, and Caesar- 
ian section must be employed. 

2. Embryotomy. In all instances, in the larger animals, 
where forced extraction is impossible or imprudent, the veterin- 
arian should diminish the size of the fetus hy embryotomy, un- 
less the fetus is still living and possesses a very high value as 
compared with that of the mother. This operation is necessarily 
limited in practice to the larger species of animals, and is virtu- 
ally excluded in the sow, bitch and cat because the size of the 
genital canal does not permit of carrying out the necessary 
operations. 

In the ewe and goat embryotomy is at times practicable, de- 
pending chiefly upon the comparative dimensions of the genital 
canal of the patient and the hand of the operator. 

In the cow we have occasionally found that the head presented 
the chief obstacle to labor, and it was only necessary to perform 
cephalotomy, as described on page 643, in order to accomplish 
delivery. If this does not suffice, the diminution in the size of 
the fetus may be continued to any further degree required, as 
suggested under d, page 645 ; g, page 649 ; and c, page 658. 

3. Caesarian section will be found necessary or advisable in 
many cases of dystokia in the sow and carnivora due to excessive 
volume of the fetus. Forced extraction is difficult because of 
the smallness of the genital passages, and frequently unwise 
because the force which would be required for the extraction 
of the fetus would produce injuries to the soft parts, of a 
more serious character than would result from gastro-hysterotomy. 
For the same reason embryotomy cannot be applied, and the 
obstetrist must turn to Caesarian section as his last resort. 

It is unfortunate in these cases to postpone the operation too 
long. The obstetrist should determine the necessity for Caesarian 
section early, and carry it out as promptly as possible. If there 
is delay in operating, and one or more fetuses have perished and 
become emphysematous and putrid, the operation becomes very 
grave ; whereas in these animals Caesarian section, when carried 
out upon a uterus which has not suffered from any previous insult 
and in which the fetuses are yet alive, is not highly dangerous. 
The operation has already been discussed on page 663. 



Death of the Fetus. 733 

b. Death of the Fetus. Fetal Emphysema. 

Simple death of the fetus prior to or during labor does not con- 
stitute a very important cause of dystokia, though the move- 
ments of the living fetus probably tend to favor easy labor by 
overcoming any tendency to a false presentation. The dead fetus 
may undergo rigor mortis, as in extra-uterine death, and this may 
tend to complicate its expulsion. 

When the fetus has been long dead, and emphysema or gaseous 
distension of the tissues occurs as a result of its decomposition, 
the fetal cadaver becomes very greatly increased in volume, and 
this may reader its expulsion exceedingly difficult or impossible. 
Not only is there an increased fetal volume in such instances, but 
the fluids escape and the hair of the fetus becomes dry and ad- 
heres closely to the uterine walls, so that it is difficult for the fetal 
cadaver to glide along the passages. The emphysema intensifies 
dystokia b}' distending the uterine cavity and causing paralysis 
of the uterine walls, from fatigue ; or it leads to infection of the 
uterine walls, with paralysis of function. The advent of 
emphysema occurring during dystokia is very prompt. If the 
cervical canal is well dilated, and the membranes are ruptured, 
emphysema may be quite pronounced within 24 hours, the fetal 
cadaver greatly enlarged, and the hair and epidermis readily de- 
tached. Within 48 hours the skeleton may begin to lose its 
integrity, the epiphyses of the bones readily separating. 

The diagnosis of emphysema of the fetus is readily made by 
the fetid odor, the enlarged puffy condition of the fetal cadaver, 
and the crepitus when the skin is pressed by the hand. 

The cause of fetal emphysema, fundamentally, is the death of 
the fetus, followed by putrefaction dependent upon the presence 
of gas-producing organisms. It is essential, ordinarily, that the 
OS uteri is open or the tissues of the cervix are seriously dis- 
eased, as in torsion, and hence incompetent to ward off the exten- 
sion of the infection through the cervical canal to the fetus. 
Under other conditions, mummification of the fetus may occur 
instead. 

Clinically, fetal emphysema may be divided into two classes — 
primary and secondary. In the first, the infection and death of 
the fetus in utero occurs prior to the advent of labor or expulsive 



734 Veterhiary Obstetrics 

efforts. In some cases almost uo labor pains are observed through- 
oiit their clinical history, and the presence of the emphysematous 
cadaver is made manifest chiefly by the protrusion of the putrid 
fetal membranes and the advent of fetid vaginal discharges. 

In the second class, or secondary emphysema, are included 
those cases in which the fetus was alive, or at least not em- 
physematous, at the beginning of labor, and in which the em- 
physema follows the expulsive efforts because of some delay 
in the expulsion of the fetus as a consequence of dystokia. The 
first class might be termed the dystokia of emphysema ; the 
second the emph5''sema of dystokia. 

Whatever the cause of emphysema, in addition to the decom- 
position of the fetal cadaver, metritis, metro-peritonitis, pyaemia 
and septicaemia are more or less frequent and intense. The uter- 
ine walls become thickened, hard and unyielding. Sometimes 
the walls are one inch or more thick, dark colored, black, or 
necrotic- green. The uterine expulsive powers are absent or 
greatly enfeebled. 

The prognosis is grave. In the cow, the extraction of the 
fetus after two or three days, or even its complete decomposition 
and sloughing out through the abdominal walls or into the ali- 
mentary tract, sometimes occurs. In fact, after emphysematous 
decomposition of the fetus has continued for a few days, the uterus 
and system acquire marked powers of resistance. 

It is the recent case of emphysema which offers the grave 
prognosis. We have seen death from septicaemia and uterine 
gangrene, in the cow, within 24 hours after the owner had first 
observed signs of labor or disease. In these cases, apparently, the 
emphysema antedated any expulsive efforts, and the uterus quickly 
lost its expulsive powers. 

Handling, i. Forced Extraction. In many cases it is ad- 
visable to bring about delivery by forced extraction, pages 586 
and 640. When forced extraction is to be attempted, we should 
first correct any deviation or abnormal condition of the presenting 
parts and then, lubricating the passages thoroughly with warm 
lysol .solution or fat, apply traction, as already directed. The 
traction should be judiciously applied, but may be quite powerful, 
becau.se, in the emphysematous state, the pressure is very evenly 
distributed over every part of the genital canal. It should be 
remembered also that the operation should not be hastened be- 



Death of the Fetus 735 

cause the gases tend to become gradually forced out when pressure 
is applied to the cadaver, so that those parts which are under 
greatest pressure become slowly but markedly decreased in size, 
because of the shifting or escape of the emphysema, and thus favor 
extraction. 

2. Embryotomy, page 641, should always be preferred to 
forced extraction if the latter involves any serious degree of force. 
Embryotomy is easier than in an undecomposed fetus, because the 
tissues are so soft and friable that they are very readily separated. 
In the performance of embryotomy it should be remembered that 
extensive punctures and incisions of the skin will allow the escape 
of large volumes of gas, by which the size may be reduced. A 
much greater reduction in size can be had by evisceration, p. 658, 
because not only do the viscera and the body cavity contain large 
quantities of gas, but also those gases which are in the tissues 
elsewhere may largely escape from the open body cavity, thus 
greatly reducing the volume. 

Fleming cites Bosetto as having had a unique experience in 
one of these cases of emphysema, in which, upon withdrawing 
his hand after some manipulation, there was a rush of gas from 
the vulva of the cow, which was inflammable and, becoming ig- 
nited owing to the presence of a candle, caused a considerable 
fiame, which burned for some time, but which produced no ill 
consequences. 

3. Caesarian Section, page 663, is usually indicated in the 
sow, bitch and cat ; almost never, if ever, in the cow and mare. 
In many of these cases, in the sow, bitch and cat, the handling 
becomes safer if the more radical operation of hysterectomy, page 
669, is substituted. The prognosis is unfavorable. 



C DISEASES OF THE FETUS. 

During intra-uterine life the fetus is subject to various diseases, 
either of the entire body or of parts, which, at the time of partu- 
rition, may cause more or less serious dystokia. These consist 
largely of dropsy of cavities or organs, by which means a portion 
of the fetus becomes greatly increased in size ; or a general 
dropsy of the entire body, anasarca, occurs. 

I. Hydrocephalus. 

Hydrocephalus consists essentially of a distension of the lateral 
ventricles of the brain with lymph. The fluid may be of any 
amount, and upon its volume, depends the degree of dystokia 




Fig. 122. Hydrocephai,us. Cai,f. (Harms). 

which it may produce. In the calf and foal it reaches, in many 
cases, the amount of 4 to 5 gallons, and then constitutes a rather 
serious impediment to the expulsion of the young. 

The cerebral hemispheres are virtually absent, while the cere- 
bellum and medulla oblongata are usually present in an appar- 
ently normal condition. The enormous distension of the lateral 
ventricles, with the prevention of the formation of cerebral 



Hydrocephalus 737 

matter, leads ordinarily to the death of the fetus as soon as the 
umbilic circulation is suspended. 

The effect upon the skull is interesting, and has an important 
relation to the question of delivery. The bony skull is usually 
incomplete, and the principal portion of the tumor or enlargement 
is wholly devoid of any osseous covering, and consists merely of 
the skin and vestiges of the meninges of the brain. At the base 
of the tumor, the bones of the skull spread outward and then 
upward to constitute a chalice-like cavity with irregular borders. 

The cause of hodrocephalus in the fetus is unknown. It is 
observed in all animals, but is most frequently seen in the calf 
and somewhat rarely in the foal. 

The diagnosis is comparatively easy when the fetus presents 
anteriorly, but may become somewhat difficult in the posterior 
presentation. When the fetus presents anteriorly, the obstetrist 
usually finds upon inserting his hand that the cranium is abnor- 




FiG. 123. Hydroceph.\lus. Calf. Skull from Fig. 122. (Harms). 
malljr enlarged and soft or fluctuating. Somewhat rarely the 
hydrocephalic cranium is complete, the osseous walls completely 
enclosing the abnormal brain. At first there may be difficulty 
in identifying the head, because of the great disproportion and 
its soft, fluctuating character. The actual diagnosis can be made 
only by identifying some definite parts of the head, such as the 
mouth, nostrils, ears or eyes, and determining that the enlarge- 
ment has a definite relation to these. 
47 



738 Veterinary Obstetrics 

In the posterior presentation, the presence of hydrocephalus is 
not likel}^ to be suspected until the entire fetus, except the head, 
has been extracted, when suddenly its progress is checked or 
completely stopped, and it becomes necessary to make an ex- 
amination in order to determine the cause. 

Handling. The indications in h^'drocephalus are the destruc- 
tion of the tumor by opening the sac and permitting the liquid 
to escape and then diminishing the size of the osseous portion 
by dividing the bone with the obstetric chisel. The incision 
into the tumor is easily made with the scalpel or ring knife, and 
the cranial bones are so thin and weak that they are easily 
broken down b}' means of the chisel, as described on page 643. 
In one case, in the mare, where the anterior limbs had not yet 
advanced into the canal, we opened the sac and allowed its con- 




FiG. 124. Hydrdcephai^us. Cai^F. (After photograph). 

tents to escape, broke down the bones, drew the head through 
the birth canal and amputated it, after which we repelled the 
neck, secured the two anterior limbs and extracted the headless 
fetus. 

When the fetus presents posteriorly, and hj^drocephalus has 
been diagnosed, the handling is analogous to that for the an- 
terior presentation. 

As a general rule, it is not essential to decrease the size of the 
head very greatly, or, in some cases, to decrease it at all by arti- 
ficial means. Fig. 124 represents a h5'drocephalic calf, which 
was expelled without aid, the head-sac of which had a capacity 
of about 5 gallons. We had been called because of the dys- 
tokia, but, pending our arrival, the calf had been expelled. 
Upon examination, it appeared that the expulsive efforts had 
compressed the sac to such a degree that it ruptured through the 



Ascites of the Fetus 739 

cribriform plates of the ethmoid bone, which allowed the escape 
of the fluid through the mouth, and the collapse of the popch. 

2. Ascites and Hydrothorax. 

The peritoneal cavity of the fetus is occasionally the seat of 
very extensive effusions. It is said that in some rare cases the 
pleural cavity may suffer similarly. The causes of fetal ascites 
are unknown. Possibl}' some cases designated as ascites are due to 
cystic distension of the fetal kidneys, ovaries or other organs. 

The symptoms of ascites, and similarl}'^ of hydrothorax, are 
confined to the resultant dystokia. It occurs almost whoU}' in 
the calf. Upon examination it maybe found that the fetus is pre- 
senting normally, and the advancing parts are of normal form 
and volume. If presenting anteriorly, there is no apparent ob- 
stacle to expulsion until the head and neck have passed the 
vulva, when progress ceases, and, although considerable traction 
may be applied, the fetus appears immovable. 

Upon examination the veterinarian finds that the abdomen is 
enormously enlarged, tense and fluctuating, and alone consti- 
tutes the obstacle to parturition. 

When the fetus presents posteriorly the symptoms are quite 
analogous ; the fetus in normal attitude advances until the hips 
enter the pelvic canal, where it stops. Inserting the hand along- 
side the fetal body, the distended abdomen may be felt and 
recognized. 

The handling of the d3-stokia consists fundamentally of re- 
leasing the fluid from the abdominal cavitj'. This may be done 
in a varietj' of ways. The operator may carrj' a finger-knife or 
concealed scalpel into the uterine cavity, and incise the abdomen 
of the fetus from without, thus allowing the fluid to escape into 
the uterine cavity of the mother. 

From the standpoint of safety to the mother and convenience 
to the operator, we prefer liberating the fluid through the chest 
cavity externally. The head and neck have already passed the 
vulva ; it is the work of but a few minutes to remove one an- 
terior limb subcutaneously, as described on page 645; after 
which one or two of the exposed fetal ribs maj' be severed. The 
operator can then evi.scerate, page 658, pass his hand through 
the chest cavity, and rupture the diaphragm, when the ascitic 



740 Veterinary Obstetrics 

fluid promptly rushes out and escapes externally. Delivery 
readily follows. 

In the posterior presentation the fluid may be caused to escape 
through the fetal pelvis by an incision through the perineum. 

3. Anasarca. 

Somewhat rarely in practice the veterinarian meets with a 
fetus, the entire body of which is edematous, so that its diameter 
is greatly increased and it appears as a somewhat rounded, soft 
mass with its tissues filled everywhere with fluid. Like ascites, 
anasarca is seen almost, if not quite exclusively, in the calf. In 
Germany this disease has acquired the designation wasserkalbe 
or speckkalbe. The fetus affected with anasarca usually perishes 
at the sixth to seventh month, and is expelled. Upon expulsion 
it appears as a rounded mass ; the skin is hairless and looks 
somewhat leathery ; the limbs and neck seem excessively short 
because of the increased transverse diameter of the fetus ; and 
everywhere through its tissues there is a vast amount of liquid, 
which freely exudes when the parts are incised. 

The causes of anasarca are not known, but some investigators 
have attributed the condition to an absence of the thoracic duct. 

Anasarca rarely offers any serious obstacle to parturition, and 
when it does so the dystokia is referable solely to the excessive 
volume of the fetus, which we have already discussed on page 
726, and should be handled in the same waJ^ 

4. Cysts and Cystic Degeneration of Fetal Organs. 

Cysts in various internal organs or in the subcutaneous con- 
nective tissue, which may so increase the size of a particular 
region of the fetus as to induce dystokia, are very rarely recorded. 
Among the internal organs, the liver and kidneys have been 
found affected with cysts of such dimensions as to constitute an 
obstacle to the expulsion of the fetus. Naturally these cysts 
cannot be differentiated clinically from ascites, and it is only 
upon post partum examination that the character of the diiE- 
culty may be fully recognized. The method of handling is the 
same as we have already suggested for ascites. 

Fleming, citing Ludke, records a cyst, in the subcutaneous 
connective tissue below the ear of a calf, which was more than a 
foot in diameter and contained 36 pounds of fluid. This had to 



Tumors of the Fetus 741 

"be punctured in order to permit the extraction of the fetus, but 
the exact nature of the disease was not determined. Was it a 
cystic thyroid or salivary gland ? 

Fleming cites Pflug, who was called to attend a goat in difficult 
labor and found a large cyst upon each side of the head of the 
kid, in the region of the parotid gland, which oifered considerable 
impediment to the extraction of the fetus, which, however, was 
finally accomplished without puncturing the cysts. 

The same author describes the case of a foal with a cystic 
distension of the guttural pouch. 

The indications in this rare group of anomalies will depend 
somewhat upon the location and volume of the cyst. When very 
large they may generally be easily destroyed by puncture, which 
allows the contents to escape; or the tumor may be so adjusted in 
position that the fetus may be extracted without the destruction 
of the cyst. 

D. TUMORS OF THE FETUS. 

It must be very rare that a fetus suffers from a tumor in the 
true meaning of that term. Fleming speaks of tumors of the 
fetus, but includes under this heading those which we have con- 
sidered in the preceding section as cysts. Among his citations 
there is only one which might possibly be regarded as a tumor 
in the common acceptance of that term. Citing Rossignol, Flem- 
ing alludes to a fetus which had, in the neighborhood of the um- 
bilicus, a tumor which weighed 1 1 pounds and was composed of 
fibro-adipose tissue. The description of the tumor is very incom- 
plete, and its nature is not revealed. 



E. ANOMALIES AND DISEASES OF THE FETAL MEM- 
BRANES AND OF THE UMBILIC CORD. 

1. Dense Chorion. It has been asserted that the fetal mem- 
branes may be abnormally thick and resistant in one case or 
abnormally thin and weak in another, and that these may result 
in more or less danger to the mother or fetus. As a source of 
dystokia, only the abnormally thick and resistant metnbranes, 
the chorion, can produce any serious results. How frequently 
these abnormalties occur in veterinary obstetrics cannot be de- 
termined. We have found no records of cases where such a condi- 
tion was clearly proven. The toughness of the chorion or other 
membrane must be merely comparative, and its existence will 
largely depend upon the interpetration of the obstetrist in attend- 
ance. Should it occur, artificial rupture or incision is demanded. 

2. Adhesions of the Fetal Membranes to the Fetus. 
Very rarely in veterinary obstetrics there are found adhesions 
between the fetal membranes and the fetus, which tend to in- 
terfere with birth. There is no part of the fetus upon which 
such adhesions may not occur. All the membranes may be in- 
volved — amnion, allantois and chorion — and cause more or less 
firm adhesions with the fetus, and may also extend to and involve 
the uterine walls. Fleming cites one instance where the adhe- 
sion took place upon the frontal region, and interfered with the 
expulsion of the calf. In other cases the adhesion has occurred 
upon the skin of the pastern and elsewhere. When such adhe- 
sions exist, and result in dystokia, they must be divided in order 
to bring about prompt delivery. 

3. Hydramnois and hydrallantois. On page 424 we have 
already described the dropsies of the fetal membranes as causing 
more or less serious interference with the well-being of the 
mother during gestation, and have there discussed the action 
necessary to be taken in these cases. 

4. Abnormalities of the Umbilic Cord. The umbilic cord 
of domestic animals is very rarely of an abnormal character, 
either in dimensions or in its tissue. It varies greatly, as we have 
already noted on page 364, in its length in various domestic ani- 
mals, but we are unaware that these variations in length have 
any special significance to the obstetrist. If very short, it natur- 
ally must rupture very early, perhaps before the fetus is completely 

742 



Diseases of the Fetal Membrattes a7id Umbilic Cord 743 

expelled. In the cow, the umbilic cord habitually ruptures 
while the calf is passing through the pelvic canal, and yet it is 
born as safely as is the foal, in which the cord usually does not 
rupture until after the complete expulsion of the fetus. 

As compared with the child, the umbilic cord in all domestic 
animals is short, and consequently does not tend to protrude 
through the vagina in advance of the fetus or to become en- 
tangled about the fetal neck or extremities. In very rare cases 
the cord has been found entangled about the neck, limbs or 
body of the fetus, but this has apparently never acquired any 
great significance. 

Even if the cord should become entangled about the fetus, it 
usually offers no important impediment to parturition, because 
it is comparatively easily ruptured in anj^ of the domestic ani- 
mals, so that any powerful expulsive effort would quickly cause 
it to part. The chief danger is the strangling of the fetus 
through compression of the cord. When the cord is found en- 
circling a part in a manner to cause its compression, the ob- 
stetrist should obviate the danger as far as po.ssible, by disen- 
tangling it or hastening delivery, according to the circumstances. 



F. ABERRATIONS AND ANOMALIES IN THE DEVEL- 
OPMENT OF THE FETUS. 

I. Campylorrhachis. 

We have met, in one case in the cow, a form of contracture, 
consisting of an abrupt lateral curvature of the spine in the 
dorsal region, by which the body was doubled upon itself in the 
middle in such a way that the two posterior feet lay with their 
ventral surfaces upward, alongside the two anterior feet, with 
their soles turned downward and the head resting upon them. 

The symptoms of this anomaly are peculiar and confusing. 
The head end of the fetus offers in the typical anterior presen- 
tation, dorso-sacral position, the anterior feet extended and the 
nose resting upon them, while alongside them, to the right or 
left, are the two hind feet with their plantar surfaces turned up- 
ward and the hocks and buttocks readily reached. The condi- 
tion at once gives the obstetrist the impression of twins, and the 
chief point in diagnosis is to determine whether the symptoms 
are due to twins or to deformity. In case of twins, one of the fe- 
tuses may be repelled while the other is advanced, but in this 
anomaly both the anterior and posterior portions must advance 
or recede simultaneously. It may be possible to reach and iden- 
tify the spinal curvature. 

The remedy is embryotomy. The most efficient plan is the 
subcutaneous removal of the two anterior limbs, by the method 
described on page 645, and evisceration of the fetus, as described 
on page 658, after which the head aud neck are to be repelled, 
the now flaccid body of the fetus converted into a posterior 
presentation by traction upon the posterior limbs, and its ex- 
traction accomplished. The repulsion of the anterior portion of 
the fetus should be quite complete, and the operator should 
continue the process with his hand as long as it is possible to 
keep his arm in the vaginal canal alongside the advancing 
posterior portion. 

2. SCHISTOCORMUS REFLEXUS. 

On page 351, while discussing the development of the embryo, 
we have stated that under certain conditions the amniotic fold 
contracts in such a manner that the spinal column is forced 
744 



Schistocormus Rejlexus 



745 



down through the abnormally wide vitelline duct, and the 
somatopleur of the embrj'o is reflected so that it is virtually 
everted, as indicated in Figs. 71, 72 and 125. This anomaly 
occurs almost wholly in the cow, though a few cases have occurred 
in other ruminants. The viscera lie naked, in the absence of a 
fetal body cavity, while the other portions of the fetus constitute 
an irregular mass, presenting the pleuro-peritoneal membrane ex- 
ternally in the form of an inverted pouch, open at one end, 
through which all four limbs and the nose may more or less pro- 




FiG. 125. Schistocormus Reflexus. (de Bruin. ) 
trude. The four legs and the head and neck lie in an inextri- 
cable mass, as in a pouch of skin. The skin, with its coat of hair, 
constitutes the lining of the pouch, and lies in contact with the 
contained limbs and head and neck. 

The diagnosis of this anomaly depends upon the anatomical re- 
lations above mentioned. Usually the monster presents by its 



746 Veterinary Obstetrics 

four feet and head, and consequently the operator at once comes 
in contact with several, or all four feet and the head. Following 
along the fetal extremities, the hand passes into a closely envel- 
oping pouch, lined with hair. Examining more externally, the 
operator's hand passes over the fetal mass and comes in contact 
with the fetal viscera lying loose within the uterine cavity. 

If presenting by the reverse end, the operator should recognize 
the viscera bnng free, and the exposed, bent spinal column and 
ribs, covered only hy peritoneum. 

Usually the condition offers rather serious dystokia. In the 
cases observed by us, fetal death, putrefaction and emphysema 
preceded the symptoms of dystokia, so that upon our arrival the 
fetus has been found putrid. 

Forced extraction and embryotomy offer the chief suggestions 
in delivery. The conglomerate, irregular outline of the fetal 
mass, with projecting ribs and other bones, renders forced extrac- 
tion too dangerous in most cases. Unless the pelvis of the cow is 
very roomy and the fetal mass very small, embryotomy is to be 
preferred. 

In performing embryotomy, the operator should have in mind 
the anatomical relations of the parts, and should first of all make 
a longitudinal incision through the skin pouch, so as to lay it 
freely open and render the limbs available for operation. He 
should then proceed to diminish the mass to a sufficient degree, 
preferably first by the subcutaneous amputation of the two an- 
terior limbs, page 645. This may be followed by the amputation 
of one or both hind limbs or of the head, as circumstances may 
suggest, until the remaining portion may be extracted without 
serious difficulty or injury to the soft parts. 

3. Contractures of the Extremities. Wry-Neck. 

Various fetal articulations undergo deformation during intra- 
uterine life, and present at birth obstacles of a more or less im- 
portant character. The campylorrhachis, mentioned on page 
744, may be regarded as belonging to this class. Abnormal 
flexion of certain joints of the limbs is not rare. The indica- 
tions, in case of dystokia due to flexures or contractures of the 
limbs, are to overcome such obstacles by forcible extension, or, 
if this fails, to amputate the offending part or relieve the con- 



Wry-7ieck in the Foal j/^."] 

tracture by tenotomy or myotomy, and remove the fetns in an 
otherwise normal manner. 

Wry- neck in the Foal. In the foal the abnormality known 
as " wry-neck " is comparatively common as a cause of dystokia. 
Wry-neck is usually described as a contracture, with the implica- 
tion that the deformation is induced by contraction or abnormal 
shortening of fetal muscles, but the actual cause is unknown. 
Usually the bones themselves are bent. The anomaly is possibly 
due to the anterior feet occupying one horn, into which the head 
has failed to enter and becomes reflected back along the fetal body 
in the body of the uterus, there to be held firmly. If the neck of 
an equine fetus becomes accidentally caught in lateral deviation, 
and is so held, the muscles on the concave side naturally shorten 
as a result. This abnormality is most frequent, or practically 
confined to the foal, apparently because of the great length of 
its neck. 

Wry-neck constitutes one of the most common and formidable 
obstacles to delivery in the foal. In these cases the neck is bent 
abruptly backward at its base, and the head lies in the flank of 
the foal. The deviation has existed throughout a long period of 
time, as is shown by the curvature of the head upon its long 
axis. If the neck is curved to the left side of the foal, so that 
the head rests in its left flank, then the left side of the head and 
face is concave and moulded to the surface of the body, while 
the right side is convex. 

In our experience, wry-necked foals usually present either an- 
teriorly, with the two forefeet more or less extended in the pas- 
sage and the head out of reach, or transversel}', with the ventral 
surface of the body toward the pelvic inlet and several or all four 
of the feet extended in the vaginal canal. 

In the anterior presentation, the operator may not be able to 
reach the head because of its extreme deviation, favored by the 
great length of the neck. If he can reach the head, it will be 
found exceedingly difficult or impossible to bring it into the va- 
gina, because when the fetus is repelled the head recedes, instead 
of tending to become extended as in case of a normally developed 
head and neck, where the head has recently become deviated. 
If the head is secured by means of hook or cord or other device, 
it is still found exceedingly difficult to bring about its extension 
in the genital passages, because of the contraction of the muscles 



748 



Veterinary Obstetrics 



and the fact that the cervical spine has been long bent and is 
quite rigid. 

When the fetus presents transversely, with all four feet in or 
near the pelvic inlet, the head is usually undiscoverable ; if it 
can be reached, it is difficult or impossible to bring it into the 
pelvic inlet. Fortunately we do not wish in these cases to ad- 
vance it into the inlet or otherwise secure it. 

The indications in instances of wry-neck vary according to 
conditions. These will be considered under Lateral Deviations 
of the Head in the Anterior Presentation, on page 765, and 
under Transverse Ventral Presentation on page 788. 

4. Double and Triple Monstrosities. 

Double monstrosities occur chiefly in the cow and somewhat 
rarely in the smaller ruminants and the sow, while in the mare 




Fig. 126. Gastrodidymus Octipes. (From a photograph. ) 
they are almost unknown. They constantly offer more or less 
serious obstacles to delivery. The symptoms of double monstros- 
ities vary according to the particular abnormality and the 
presentation. 

Commonly, where a fetus is double at one extremity only, it 
presents by that extremity, and consequently the abnormal por- 
tion of the fetus is within reach and the diagnosis can be made by 
manual exploration. A double face, head, neck, or chest is 



Double and Triple Monsb'osities 



749 



usually easy to differentiate by palpation. Double monstrosities 
in which the double condition affects the posterior extremity 
only, if presenting posteriorly, enable the operator to reach for- 
ward a sufficient distance to properly examine the point of 
bifurcation and diagnose the double character of the fetus. 

In those cases where the single end of the fetus presents and 
enters the pelvic inlet, the dystokia is not apparent until the 
double portion reaches the pelvic inlet and its progress is stopped 
because of the abnormal size. Then the obstetrist, in making an 




Fig. 127. Tetrachirus Choristocephalus. (Gurlt). 

examination, should be able to pass his hand alongside the .single 
portion of the fetus until he reaches the double portion, the 
character of which, especially the spinal bifurcation, should be 
recognized by the sense of touch. 

In the complete double monster, like the thoracopagus and 
others of similar type, Figs. 126 and 127, the obstetrist finds the 
two corresponding portions of the body advancing simultaneously, 
and cannot repel or advance the one without moving the other 
in a corresponding direction. Moreover, as a general rule he 
will be able to reach that portion of the two bodies where they 
are connected, and thus determine the character of the anomaly 
with which he has to deal. 

In the very rare pigodidymus aversus. Fig. 129, it would be ex- 



750 



Vetermary Obstetrics 



ceedingly difficult to diagnose the condition until the presenting 
portion of the monster, or we might say the presenting fetus, is 
completely withdrawn or at least its croup enters the pelvic inlet, 
when the breech of the second or posterior twin reaches the 
pelvic inlet, becomes impacted in it and stops further progress. 
If the operator will then examine carefully, he may be able to 
reach sufficiently far to determine the character of the monster 
with which he has to deal. 

The indications in cases of double monsters vary. In many 
instances they are comparatively small, so that the double con- 




FlG. 128. SCHISTOCEPHAIvUS. CaLF. 

dition does not prevent their extraction entire without serious 
difficulty. In other cases it is necessary to resort to embryotomy 
in order to bring about delivery with safety to the mother. 
There are no specific rules for the operation of embryotomy, but 
the reduction in the size of the monster is to be carried out ac- 
cording to the general suggestions already made on page 641. 

It may be well to suggest that it is highly desirable, whenever 
possible, to divide the double monster into its two halves. That 



Double and Triple Monstrosities 



751 



is, if there exists a double head and neck, we should, if possible, 
amputate one of the necks with the chisel or by other means, and 
remove it, and then proceed to extract the remaining portion of 
the fetus. So we would handle a posterior presentation where 




the posterior extreniitj' of the fetus is double. Or we may re- 
duce the volurne of the double body by evisceration, page 658, 
by the destruction of the pelvic girdles, or by amputation of the 
hind limbs, page 653. 



752 Veterinary Obstetrics 

5. The Dystokia of Twins. 

Twins occasionally induce dystokia, and may at times cause 
confusion in diagnosis. 

The diagnosis of twin or triplet pregnancy, when dystokia oc- 
curs, is usually not very difficult, especially if the fetuses have 
not become impacted in the pelvic canal, so that tbey are immov- 
able. When they produce dystokia, it is usually because one or 
more extremities of each fetus has entered the pelvic canal. 

A little carelessness may lead to an error. If one fetus is pre- 
senting posteriorly and the other anteriorly, there may be present 
in the passages the head and one forefoot of one fetus and one 
hind foot of the other fetus. This latter may be mistaken for a 
fore-foot of the former, or other similar error be made if proper 
care is not taken. 

In other cases there may be such a deformity of a single fetus 
that it may be mistaken for twins. Especially is this the case in 
camp5'lorrhachis, which we have already described on page 744. 

The differentiation between twins and double monstrosities is 
usually not difficult. In case of double monstrosities the two 
parts necessarily move in harmony ; they advance or retreat 
together, and each movement that one is caused to make is at once 
accompanied by a corresponding movement of the other. This 
is not true of twins. 

The indications for handling dystokia due to multiparity are 
comparatively simple. The operator needs repel one fetus, or 
rather the presenting parts of one fetus, and advance the other. 

It is essential that the one fetus shall be repelled entirely into 
the abdominal cavity, and kept there until the pelvic canal is 
fully occupied by the fetus which is being advanced, after which 
it is delivered. The other is then brought into position, and 
also extracted. Deviations of the extremities of twins are 
subject to the same rules as those of single pregnancies. Twins 
are usually smaller than single young, and permit of easier 
handling and correction of position. 



C. ABNORMAL PRESENTATIONS OR POSITIONS 
OF THE FETUS. 

I. ANTERIOR PRESENTATION. 

a. Dorso-Ilial or Dorso-Pubic Positions. 

In the larger domestic animals, where the fetus normally lies e7i 
arc or describes in its attitude the segment of a circle, the ventral 
surface concave and the donsal convex, it is essential to the easiest 
delivery that the fetus should be in the dorso-sacral position. The 
body does not readily bend dorsalwards, because the inferior wall 
of the fetus is comparatively short and inextensible and, with the 
viscera in position, the rigidity of the fetal body is maintained. 
A further obstruction to its passage, in other position than the 
dorso-sacral, is that the greater diameter of its body does not 
correspond with the greater diameter of the pelvic canal. It is 
possible in some cases to bring about the extraction of the fetus 
in the dorso-ilial or dorso-pubic position, but this is chiefly in 
those cases where the fetus is comparatively small as related to 
the genital passages of the mother. When the fetus is so small 
that it can be brought out in this unfavorable position, its 
diminutive size permits the correction of the position to be made 
with very little labor. 

The indications are usually to rotate the fetus upon its long 
axis, and convert the dorso-ilial or dorso-pubic into the dorso- 
sacral position. Under special conditions it may be advisable or 
practicable to resort to forced extraction. We have already dealt 
with the question of rotation on page 632, and of forced extraction 
on page 586. Both of the.se failing, it may be necessary to resort 
to embryotomy, consisting of the subcutaneous amputation of 
one anterior limb, page 645, and evisceration, page 658, followed 
by rotation. 

b. Deviation of the Anterior Limbs. 

The anterior limbs of the fetus are subject to greatly varying 
deviations. While these may sometimes be unimportant in the 
smaller species, the}^ become of fundamental value in the larger 
animals, such as the foal and calf. The long and rigid limbs 
and neck of these make it essential that each extremity should 
be fully extended in order to pass readily through the pelvic 
48 753 



754 



Vetermary Obstetrics 



canal. Any deviation from this normal attitude is liable to result 
in more or less serious difficulty in the expulsion of the young 
animal.. 

I. Flexion of the Anterior IvImbs at the Elbow. 
Anterior Limbs Incompletely Ex- 
tended IN THE Pelvis. 

It is not very rare to meet with instances in the calf and foal 
in which the two anterior feet present in their normal position 
and appear at the vulva, accompanied generally by the nose, 
which is advanced to nearly the same degree as the feet them- 
selves. At first glance the position seems to be essentially normal, 




Fig. 130. Incomplete Extension of Anterior Limbs. 
but, when the fetus has reached the point where the feet and nose 
are visible, its advance becomes checked and the expulsive efforts 
of the mother are quite unavailing to cause any further progress. 
The interpretation of this condition varies somewhat with dif- 
ferent writers. Fleming says : " It is usually due to the shoulders 
not being closely applied to the chest of the fetus, and the elbows, 



Abnormal Presentations of the Fetus 755 

consequently, thrown widely apart, coming in contact with the 
brim of the pelvis, thus proving an obstacle to the progress of 
the young creature." 

We interpret it as purely a flexion of the humero-radial articu- 
lation, the consequent or coincident pushing of the shoulders 
backward upon the sides of the chest, and the impaction of the 
olecranon against the pubic brim. In this position, the trans- 
verse diameter of the chest of the fetus is greatly increased by 
the retention upon its sides of the entire volume of the fetal 
shoulders, including the scapula and scapular muscles, the hu- 
merus and the bulky anconean group of muscles. The perpen- 
dicular diameter of the fetus is also greatly increased, because it 
must represent the distance from the top of the spinous processes 
of the dorsal vertebrae down to and including the olecranon, the 
latter projecting downward to constitute an unyielding obstacle 
which becomes lodged against the pubic brim. The condition 
naturally belongs to the dorso-sacral position. 

The diagnosis depends fundamentally upon two facts. While 
the two forefeet present normally and the nose is resting on top 
of them in a normal position, so far as it is independently con- 
cerned, there is an abnormal relation between the degree of ad- 
vancement of the feet and the nose. While normally the nose of 
the fetus rests about the middle of the metacarpus, in these cases 
it is advanced to the fetlock or even further. Under these con- 
ditions, if the obstetrist will introduce his hand along the ante- 
rior limbs until he reaches the brim of the pubis, he will find the 
olecranon tightly impacted against the pubic brim. 

The indications are simple and obvious, and consist merely in 
releasing the olecranon from its incarceration in front of the pubis 
and the proper extension of the limb in the birth canal. Little, 
if any repulsion is required. When both limbs are retained, each 
should be handled separately. The operator should insert his 
hand along the inferior surface of the limb, with the palm turned 
upward, until it has been forced between the pubis and the ole- 
cranon, so that the latter rests in the hollow of the hand. An 
assistant is then to exert traction sharply upward and backward, 
while the operator cau.ses the olecranon to glide over the pubic 
brim and the anterior limb to become extended in the pelvic 
canal. The same operation is carried out upon the other limb, 
after which the fetus is delivered under ordinary, precautions in 
the dorso-sacral position. 



756 Veterinary Obstetrics 

2. The Fore-limbs Crossed Over the Neck. 

It is very rare that an anterior limb of the fetus becomes 
crossed over its head while passing through the birth canal in 
other animals than the mare, and even here it is not very com- 
mon. Such displacement in the foal offers a considerable ob- 
stacle to parturition, partly owing to the obstruction of the car- 
pus lying on top the fetal poll or neck, largely because it induces 
the same position of the shoulder and elbow as we have already 
described in the previous section. By this displacement the di- 
ameter of the chest is greatly increased and the olecranon, instead 
of being in a horizontal position, projects downward almost per- 
pendicularly, and thus constitutes a very serious obstacle to the 
advancement of the fetus along the birth canal. 

There is the further very important danger that, when a foot 
is so misdirected, it is liable to become engaged in the roof of 
vagina and, perforating it, cause a rupture of the rectum or of 
the perineum. 

The false position of the deviated foot or feet is readily recog- 
nized upon examination. 

Handling. It is not difficult ordinarily to seize the misdi- 
rected foot with the hand and, while exerting some traction upon 
it, pus'a it toward the side where it belongs, first somewhat up- 
ward to cau.se it to glide over the poll, thence in a lateral direc- 
tion and downward, and finally toward the central line to bring 
it beneath the head and neck. If both feet are crossed over the 
head, as it is alleged occurs in rare instances, that one which is 
uppermost, the one which is crossed over the other foot as well 
as over the head, should fir.st be brought into position, after 
which the other is to be similarly handled. It is not essential to 
repel the fetus, unless the fore-foot has become engaged in the 
roof of the vagina and has pushed its way into it so far that the 
repulsion is necessary to its disengagement. In such cases the 
repulsion should be merely sufficient to enable the operator to 
bring about the necessary replacement of the foot. 

Should the replacement of the limb prove difficult, it is ad- 
visable to cord the foot and have an assistant exert traction 
upon it in such direction as the operator may indicate, while 
he guides and aids the reposition directly with his hand. After 
completing the replacement of the foot into its normal position. 



Flexion of Atiterior Limbs at Carpus 



757 



the operator should take the further precaution to see that the 
elbow is completely extended, before any traction is applied 
to other portions of the fetus, because, until this is done, the 
position remains such that expulsion cannot readily occur. 

3. Flexion of the Anterior Limbs at the Carpus. 

This obstacle to birth occurs chieflj' in the calf and foal, and to a 
lesser extent in the lamb and kid, but in these cases it is very rare 
and of less significance. In carnivora and the sow the condition is 
not present, or not of moment as a cause of d3'stokia, because the 
limbs are short and may readily fold backward and permit the 
head to present alone. 




Fig. 131. Fi,EX0RE of the Anterior Limbs at the Carpus. 
(St. Cyr.) 

In such cases the metacarpus is flexed upon the radius, the ra- 
dius upon the humerus, and the humerus upon the scapula, so 
that the entire limb is folded and the shoulders are pushed back 
upon the chest, thus greatly increasing the perpendicular and 
transverse diameters of the fetal body in the region of the chest, 
and offering a very great obstacle to its expulsion, which is 
greatly heightened by the impaction of the carpus in the pelvic 
canal, or in front of or beneath the pubic brim. 



758 Veterinary Obstetrics 

Normally the fetus, until just prior to birth, lies somewhat up- 
on its side with all the limbs flexed along the ventral surface of 
its body, the radius upon the humerus and the metacarpus upon 
the radius in such a way that the very long limbs of the foal 
and calf occupy the least possible space in the uterus. When ex- 
pulsive efforts set in, should the fetus be dead, the limbs may 
remain flexed during parturition, just as they were prior to the 
beginning of that act. Should the fetus be alive, it is quite pos- 
sible that, because of close investment by the fetal membranes,, 
its feet may not become extended upon the carpus. Consequent- 
ly the fetus approaches the pelvic inlet with the limbs still flexed, 
in which case they almost inevitably become impacted in the 
pelvic cavity, or beneath or against the pubic brim, to constitute 
a more or less serious obstacle to delivery. 

Some obstetrists hold that the displacement may occur other- 
wise. They claim that at the moment when the limbs of the 
fetus enter the pelvic inlet they may not be fully extended, and 
the toes may become caught against the border of the pubis. 
As the fetus advances the limbs become flexed at the carpus, and 
later the metacarpus and phalanges become directed backward, 
and the folded limbs thus applied against the neck. If we study 
carefully the mechanism here proposed, we find it probable that, 
if it came about in this manner, when the parts became folded 
the carpus would be far advanced in the pelvis along the side of 
the neck of the fetus. This, as every obstetrist well knows, is very 
rarely the case, but instead the flexed carpus is engaged against 
or beneath the pubic brim, a position which it could acquire only 
with the greatest possible difficulty, by the method which has 
been suggested. 

Another objection to the theory of the flexion of the carpus 
during parturition may be realized by the obstetrist when he at- 
tempts to extend the flexed member so as to bring about the 
extraction of the fetus. He finds at once that the length of the 
metacarpus exceeds the perpendicular diameter of the pelvis and 
that the limb has to be pushed completely back into the abdomen 
in order to be extended. If the mechanism of this flexion, as found 
in dystokia, is of the character here alleged, when the flexion is- 
coming about it would tend to become stopped by the carpus- 
abutting against the sacrum and becoming lodged in a perpen- 
dicular position across the pelvic inlet. 



Flexion of Anterior Limbs at Carpus 759 

We consequently regard this deviation as being usually a per- 
sistence of the pre-parturient attitude of the limb of the fetus, 
and not as an acquired deviation of the part. Consequently we 
may well find both anterior limbs flexed at the carpus, and the 
head of the fetus flexed ventralward, with its chin resting up- 
on the sternum. This attitude of the fetus is especially frequent 
in cases of abortion in the mare, where the dead fetus quite fre- 
quently presents by the poll and the two carpal joints. 

Sometimes one foot presents normally, along with the head ; 
sometimes the head only ; and sometimes one anterior foot only. 
Any one of these suggests at once that there is either a flexion 
of the carpus which checks delivery, or else that the anterior 
limb has been completely retained. It is thus essential to diag- 
nosis that a manual examination be made. 

In the mare and cow the retention of the anterior limbs at the car- 
pus usually constitutes an insurmountable obstacle to parturition, 
except artificial as.sistance is given. Saint-Cyr properly suggests 
that the dystokia does not result so much from the flexion of the 
carpus itself as it does because all the long bones of the anterior limb 
are flexed upon each other and the entire mass of the shoulder 
and limb is pushed backward upon the chest walls, to abnormally 
increase the transverse and perpendicular diameters of this por- 
tion of the body and render it so gross that it cannot pass through 
the birth canal without the deviation being first corrected. 

The indications are to secure the deviated limb or limbs and 
to bring them into their normal position. The position of the 
fetus is usually dorso-sacral, but, should it be dorso-pubic or 
dorso-ilial, the same general rules for the correction of the de- 
viation apply in the main, and in many respects are actually easier 
than though the fetus were in the normal or dorso-sacral position. 

I. Mutation. In order to bring about the extension of the 
limb or limbs, repulsion of the fetus is necessary. If the head of the 
fetus, with or without one anterior limb, has advanced only a short 
distance along the pelvic canal, it may be quite practicable to push it 
back into the uterus and acquire room for the correction of the de- 
viation in the abdominal cavity. If the fetus is very small, or the 
pelvis of the mother quite roomy, it may be possible to repel the 
fetus after its head has passed completely beyond the vulva, but 
this generally proves very difficult, and frequently impossible. If 
the fetus is dead, which is generally the case with the foal, and 



760 Vetermary Obstetrics 

the head has passed beyond the vulva or can readily be brought 
beyond it, the most desirable method of procedure is to resort at 
once to decapitation, as described on page 642, and then repel. 
The decapitation is a very simple procedure uuder these condi- 
tions, decreases very greatly the amount of labor required for 
repulsion and the time neccessary for the correction of the devi- 
ation, and thereby very largely increases the favorable outlook 
for the mother. 

When the head of the calf has passed beyond the vulva, its 
prominent and blunt poll makes its repulsion more difficult than 
that of the foal. Hence, if the head has protruded beyond the 
vulva and the calf is dead or is of little or no value to the owner, 
or if the conditions are such that the life of the mother will be 
greatly jeopardized by tedious repulsion, the obstetrist, as in the 
foal, should at once proceed with decapitation. 

Pronounced elevation of the posterior parts of the body greatly 
facilitates repulsion. In the ewe and other small animals, the 
patient may be almost or quite suspended by the hind legs in order 
to favor repulsion. Tepid unctuous fluids may then be introduced 
through the vulva into the vagina by gravity. The fluid lubri- 
cates the walls, rendering fetal movements more easy, and the 
weight of the liquid contributes toward repulsion. The repulsion 
may be aided by manual force. 

Having accomplished repulsion, with or without decapitation, 
as described on page 595, the obstetrist should first secure 
the anterior limb, or limbs, with the hand or by means of cords. 
First, if practicable, lift the bent carpus from beneath the pubis 
and carry it up into the pelvic canal. Then place a cord upon 
the pastern as described on page 579. When this has been 
secured, the operator proceeds to extend the limb as described on 
page 636. 

As soon as the toe has been brought into the birth canal, the 
foot is quickly extended, and the entire anterior limb is brought 
into complete extension by traction. The other forefoot, if 
retained, is handled in the same manner. 

If the head is also deviated, it is to be handled according to the 
directions given under C on page 765. After proper adjustment 
of the relations between the two anterior limbs and the head, the 
delivery is proceeded with in the usual manner. 

When this deviation occurs in the dorso-ilial or dorso-pubic 



Flexion of Anterior Limbs at Carpus 761 

position, its correction is usually easier than when the fetus pre- 
sents dorso-sacrally, and is to be brought about in a corresponding 
manner. If the fetus is presenting in a dorso-pubic position, it 
will be necessary to press the carpus downward in the front of 
the pubis and bring the toe of the foot along beneath the sacrum 
in order to extend it. In the dorso-ilial position, the retained 
carpus is pushed outwards in front of the shaft of one of the ilia, 
while the toe is carried over the ilium of the other side and ex- 
tended in the birth canal. After the hmbs have been properly 
extended in the birth canal, the fetus is to be rotated upon its 
long axis, page 632, and brought into the dorso-sacral position. 

2. Forced Extraction. Under certain conditions forced ex- 
traction may be advisable. Some obstetrists highly recommend 
it, especially in the case of a living foal. Naturally, it is only 
practicable in those cases where the bent carpus is already ad- 
vanced in the pelvic canal, or is in a position where it may be 
readily secured and brought into the pelvic canal in its state of 
flexion. In these cases, especially when a foal is living and 
prompt delivery is essential to the preservation of its life, the 
flexed carpus may be grasped by the hand, or a cord may be ap- 
plied to it. By exerting firm traction, the shoulder, arm and 
forearm are normally extended, the flexed carpus advanced, the 
entire bodj' then advanced by the application of force, and the 
fetus delivered. 

3. Embryotomy is rarely demanded except to the extent of 
the preliminary decapitation, which is desirable in order to facili- 
tate repulsion. It is rarely, if ever, essential or advisable to 
amputate the anterior limbs at the carpus. 

3. CoMPi^ETE Retention of the Anterior Limbs. 

Instead of the limb being flexd at the carpus, as in the pre- 
ceding instance, we meet with cases in which one or both anterior 
limbs are completely retained, and assume the position shown in 
Fig. 132. Under these conditions one or both carpal articula- 
tions project down deeply into the uterine cavit}' in front of the 
pubis of the mother, with the radius fully extended upon the 
humerus, so that those two bones constitute one elongated, rigid 
column. In this position of the fetus there can be no yielding 
in a posterior direction from the scalpulo-humeral articulation to 
the carpus. As a consequence of this deviation, the shoulders of 



762 



Veterinary Obstetrics 



the fetus are pushed back upon the sides of the chest so as to 
greatly increase its transeverse diameter, while the perpendicular 
diameter is still more profoundly increased by the rigidity of 
the limb, and now equals the distance from the fetal withers or 
back, to the carpus. 

The causes of this deviation may be two. When a fetus pre- 
sents at the pelvic inlet with one or both carpal joints flexed, 
these become impacted against the pubis, and, as the fetus con- 




FiG. 132. CoMPi,ETE Retention of the Anterior Limbs. 
tinues to be advanced by the expulsive efforts of the mother or 
by traction, they tend to glide downward and finally backward 
in a way to convert the flexed carpus into complete retention of 
the anterior limb. 

It is quite possible that in many instances the fetus approaches 
the pelvic inlet with the limbs extended backwards, due to an 
arrest in their forward extension. With the anterior limbs of the 
fetus folded against the ventral surface of its body, a small 
amount of force, applied to the lower end of the radius, pushes 
it backward, and causes the fetus to offer at the inlet with the 
entire forelimb retained. 

The position is not abnormal for the smaller domestic animals. 



Cotnplete Retention of Anterior Limbs 763 

For the carnivora the position is more favorable for easy delivery 
than though the anterior limbs were extended beneath the head. 
It is only in the larger domestic animals that this position be- 
comes abnormal and interferes seriously with parturition. 

The diagnosis is comparatively easy. The condition permits 
the advancement of the head and neck to a further degree than 
when the limbs are flexed at the carpus. Consequently, as a 
rule, when the veterinarian is called the head has passed beyond 
the vulva. Upon examining with the hand, the differentiation 
between the complete retention of the anterior limbs and their 
flexion at the carpus is easily made. 

Handling, i. Mutation. The indications are to correct the 
deviation of the anterior limb or limbs. The fetus must almost 
always be repelled, page 595. Before this can be accomplished 
it is best, unless the fetus is living, to decapitate, as described on 
page 642. With or without decapitation, the repulsion should 
be made backward and upward, assuming that the fetus has pre- 
sented in the dorso-sacral position. As the fetus is repelled, the 
forearm tends to come within reach, so that it may be grasped. 

The beginner especially should bear in mind that, the further 
upward and backward the fetus is repelled, the nearer the radius 
approaches to the pubis, and consequently the more readily it is 
reached. Without repulsion it is frequently quite impossible to 
reach the radius at all. As repulsion progresses and the radius 
comes within reach, a cord should be passed around it and a run- 
ning noose applied as low down toward the carpus as is possible. 
Drawing from time to time upon the cord with which the limb is 
secured, the operator should continue the repulsion and, with the 
aid of the cord and the operator's hand, bring the limb into the 
position of carpal flexion described in the preceding section. 
From this point the operation is the same as described under that 
head. 

2. Forced Extraction has been suggested by some. It is fre- 
quently practicable in the sheep and goat. In the mare and cow 
we consider it wholly unwarranted. It is said that some veter- 
inary obstetrists have succeeded in the forced extraction of the 
foal or calf in this position, but the records in the cases are not 
sufficiently lucid to enable the reader to determine whether they 
were dealing with an average sized fetus or with an abortion at 
a comparatively early period in gestation. When a fetus is not 



764 Veterinary Obstetrics 

fully developed, its limbs are comparatively much shorter and 
far more pliable, and consequently it may be forced through the 
passage in almost any conceivable position, dependent upon its 
size. When the fetus has reached its normal dimensions and at- 
tained the degree of rigidity regularly shown at the time of birth, 
the question of the correct position of each extremity becomes 
one of fundamental importance, and whenever we attempt to 
bring about forced extraction under these conditions we must as- 
sume an extraordinary risk. If a fetus can be drawn away by 
forced extraction when an anterior limb is completely retained, 
it must be because it is a very small fetus, in which instance 
there is no necessity for forced extraction, because the deviation 
is easily corrected. 

3. Embryotomy, Except the amputation of the head, which 
we alwaj's advise, embryotomy is rarely demanded in this devia- 
tion. Fleming states : " Amputation of the head will not always 
prove advantageous in retropulsion ; indeed, it will often be 
found to be a disadvantage." Upon what clinical facts such an 
opinion is based we are not aware, and cannot readily understand 
how amputation of the head could in any case prove disadvanta- 
geous in bringing about repulsion of the fetus. It is possible 
that sometimes further embryotomy may prove desirable. If the 
head has been removed, and, after repulsion, it is still impossible 
of impracticable to correct the deviation, especially in cases of 
emphysema of the fetus, it may become desirable to remove one 
or both of the shoulders. This cannot be done by subcutaneous 
amputation, described on page 645 ; but it would be necessary to 
divide and detach the skin over the region of the shoulder and 
follow this by a division of the muscles which attach the scapula 
to the chest. 

These are chiefly the trapezius and rhomboideus, which would 
free the superior end of the scapula and permit it to be secured 
by means of a cord with a running noose. Then should follow 
the division of the latissimus dorsi and the pectoral muscles, after 
which the limb may be drawn out from the skin covering it, in 
an inverted manner. After the one limb has been removed, the 
chest of the fetus may be opened and evisceration, page 658, em- 
ployed. Further diminution in size of the fetus may be prose- 
cuted to any desired extent, and the remnant finally drawn away. 



Complete Retention of Anterior Limbs 765 

c. Deviations of the Head and Neck. 

In domestic animals, the tendency for the head to become more 
or less deviated at the time of birth varies greatly because of the 
differences in the length of the neck as compared to its transverse 
diameter. In the pig, where the neck is thicker than its length, 
it is very difficult for the head to become deviated, in marked 
contrast to the foal, with the very long and slender neck, in which 
these deviations are among the most common and serious forms of 
dystokia. Not only is the head of the foal very liable to deviation 
at the time of birth, but frequently the head and neck have be- 
come bent laterally at a very early date in gestation and have re- 
mained so throughout the development of the fetus, constituting 
a serious deformity — wry-neck. 

I. Lateral Deviation of the Head. 

The most common form of deviation of the head is the lateral, 
as it is in this direction that the neck is most flexible and the 
head most readily displaced. The deviation may occur with 
equal facility to the right or the left. 

The causes of lateral deviation of the head are two. In the 
foal the deviation frequently occurs during an early period of 
gestation, to constitute wry-neck, so that when the end of gesta- 
tion arrives the head and neck have already been doubled back 
along the side of the foal for weeks or months, the parts have 
become thoroughly adapted to this position, and the head lies in 
the flank of the foal, where it is moulded to the convex surface 
of its body. That side of the head in contact with the body of 
the foal is concave, and the opposite side convex. 

The second, and except in the foal, perhaps the only cause of 
deviation, and the one which is most subject to remedy, is an 
accidental misdirection of the head at the time of the parturition. 
As the fetus, in an anterior presentation, is being forced along 
the genital canal, the nose or other portion of the head becomes 
somewhat deflected to the right or the left, and, becoming im- 
pacted against some projecting portion of the pelvis or genital 
canal or entangled in some way in the fetal membranes, is drawn 
farther to one side, until it becomes caught between the side of 
its body and the wall of the uterus or vagina. When this oc- 
curs it is highly improbable that delivery can proceed spontane- 
ously, but instead the head tends to become farther and farther 



766 



Vetermary Obstetrics 



deviated as the body of the fetus is pushed more and more for- 
ward. Finally the neck is doubled directly backward as far as 
possible from the shoulder, and the head lies far back in the flank. 

The diagnosis of this deviation usually offers little difficulty. 
It generally needs to be differentiated from only the two succeeding 
forms of deviation, the downward and upward displacements. 

First, the operator must identify the two anterior limbs, one 
or both of which are ordinarily in the passages. Having accom- 
plished this, he is yet to determine whether the head is deviating 
upward or downward, or, if laterally, whether it be to the right 
or to the left. 




Fig. 133. IvATERAi, Deviation of the Head. (St. Cyr. ) 

The determination of the direction is not always easy. If the 
head can be reached, that decides the question. When the head 
cannot be reached with the hand, the diagnosis becomes more 
difficult. As a general rule it is only in the foal that the head 
cannot be reached and examined with the hand, and in the foal 
we are aided by the presence of the somewhat prominent mane. 
If the head is bent laterally and the operator passes his hand as 
far as possible along the presenting portion of the fetus, he will 
usually be able to identify the withers. From this point, turning 



Lateral Deviation of the Head 767 

either to the left or the right and then backwards, he may trace 
the top of the neck, bearing the mane. At the lower margin of 
the neck, the operator will usually be able to identify the trachea. 
In one direction he can trace this to its point of disappearance 
within the fetal chest between the two anterior limbs, and in the 
other may follow it across the right or left anterior limb to later 
turn backward toward the patient's head. 

In the upward and downward deviations of the head, the rela- 
tions of the trachea and the superior border of the neck or mane 
are wholly different, and serve to distinguish these displacements. 
In the upward deviation of the head, the top of the neck or the 
mane is out of reach, whereas the lower margin of the neck or 
the trachea is quite fully exposed, and curves upward and then 
backward above the withers and disappears. When the devia- 
tion is downward, the trachea cannot be discovered, but the 
superior portion of the neck or the mane disappears downward 
between the two anterior limbs. 

The indications in lateral deviations of the head will vary 
greatly according to species and individual cases. 

I. Mutation. In those cases where the deviation is recent, 
where wry-neck is not present, where the fetus is not emphy- 
sematous or there are no other evidences of insurmountable 
obstacles to the correction of the deviation, this is the conserva- 
tive and proper course. The cow or mare should be operated 
upon in the standing position, with the hind parts elevated, or, if 
recumbent, should be placed in lateral recumbency on the side 
opposite to the fetal head, with her hind-quarters elevated. 

The operation consists, first, of repulsion, as described on page 
595, which is to be applied to the chest of the fetus, directed 
obliquely backward and away from the misdirected head. If 
the head is deviated to the right side of the mother, the repulsion 
should be obliquely toward her left side, so as to tend to release 
the head and cause it to advance toward the pelvic inlet. 

After repulsion has been accomplished, the operator should 
secure and extend the head of the fetus by those means most 
available in the particular case, under the rules laid down on page 
636. In many instances it is merely necessary to grasp some 
portion of the head with the hand or fingers, and give it a sharp 
pull, by which it is brought into its normal position. When the 
nose is pointing backward, that is, toward the anterior part of 



768 Veteriftary Obstetrics 

the mother, the nostrils and commissure of the hps offer a secure 
hold for the finger of the operator or for the insertion of a blunt 
hook, and this hold ma}^ prove of value until the head has turned 
somewhat. 

In the correction of this deviation it will often prove highly- 
advantageous to place a repeller securely against the chest of the 
fetus and have an assistant maintain constant repulsion, thus 
keeping the body of the fetus pushed awaj' from the pelvic inlet 
in a manner to insure to the operator the greatest amount of room 
for manipulating the head. 

In the bitch, cat and ewe, the patient may be more or less sus- 
pended by the hind legs, the vagina filled with a warm, unctuous 
fluid, and the fetus repelled, partly by gravity, partly by the pres- 
sure of the fluids, aided by shaking the animal, by pushing upon 
the fetal limbs or by means of a finger-tip placed against the 
chest. When repulsion has been accomplished, the operator 
may locate the fetal head through the abdominal wall, and by ex- 
ternal manipulation push it upward (the patient being suspended 
by the hind feetj toward the vulva, while a finger or fingers in- 
serted in the vulva aid in adjusting the head in proper position, 
after which traction may be applied. 

2. Forced extraction has been advised in the mare bj' some 
veterinarj' obstetrists, and a few of them have reported good re- 
sults by this method. It has been suggested by some that by 
this means it is possible to save a foal, though we have been un- 
able to find a record of so fortunate an occurrence. 

The plan of forced extraction has already been described on 
page 640. We have not had occasion to apply this method of 
delivery in the mare or other animal, but wehave observed a con- 
siderable number of instances in which others have done so, and 
have learned definitely of but one instance in this country where 
the life of the mare has been saved, and none where the fetus has 
not perished. In European countries there are a number of rec- 
ords of successful deliveries of mares, in these cases of dystokia, 
by forced extraction. 

There was entered in our clinic a mare from which a fetus in 
this position had been extracted by force. Her perineum was 
completely ruptured, the afterbirth was retained, she was very 
weak and exhT.usted, and presented a repulsive and pitiable sight. 
The afterbirth was removed, and the ruptured perineum was dis- 



Lateral Deviatio7i of the Head 769 

infected. In a few days she succumbed, and upon post-ynortem 
examination there was found a small perforation upon the floor 
of the cervix uteri, which had caused a septic peritonitis. 

We consider forced extraction in this position in the mare as 
unnecessary, unsurgical and brutal. There is one possible ex- 
ception to this condemnation — if the foal is known to be alive, 
cannot be promptly extracted otherwise and its life preserved, 
and there is a possibility of saving its life by forced extraction. 
Under all other conditions we hold that embryotomy is far safer 
for the mare, requires little labor upon the part of the obstetrist, 
is on the whole one of the easiest forms of embryotomy with 
which the veterinary obstetrist is acquainted, and offers to him 
the most favorable prognosis. If a fetus is so small that it can 
be safely extracted by force, without correction of the deviation 
or embryotomy, then it is so small that it need not be extracted 
by force, because the deviation can be easily corrected or embry- 
otomy can be very readily performed. We consequently see no 
good reason for forced extraction, and consider that such a plan 
should be constantly and vigorously condemned. As the calf has 
a very blunt poll and a thick head, forced extraction becomes 
highly dangerous in the cow and should not be considered. 

3. Embryotomy constitutes one of the most practical and 
favorable methods for overcoming dystokia due to the lateral 
deviation of the head in the mare and cow, if the displacement 
cannot be readily corrected. Nowhere in obstetrics has embry- 
otomy a more favorable application than in this deviation, 
especially in those cases of foals where wry-neck is present, which 
renders it extremely difficult, if not impossible, to bring about a 
correction of the vicious position. In all those cases where the 
fetus is dead and the head is deviated laterally to so great an 
extent that it cannot be readily adjusted, or even if the fetus is 
alive and of comparatively little value or if it is evident that its 
life cannot be saved, embryotomy should be proceeded with at 
once. 

While the veterinarian should not undertake embryotomy 
when the deviation can readily be corrected, he should be equally 
careful not to exhaust his physical powers in a vain endeavor to 
bring about a correction of the deviation before he resorts to 
embryotomy. The operation consists of the subcutaneous removal 
of one anterior limb, as described on page 645. The limb away 
49 



770 Veterinary Obstetrics 

from which the head is bent, and which is thereby fully exposed, 
is the one to be selected for amputation. After the removal of 
the anterior limb, the chest should be opened at the exposed 
point and evisceration carried out, as described on page 658. 
When this has been accomplished, and the fetal ribs have been 
severed, the size of the presenting portion of the fetus is re- 
duced to such a degree that it is now no greater with the head 
turned back than it would have been had it presented normally. 
It may then be drawn away with the head deviated, or what is 
usually better, the fetus has now become very flaccid and much 
room is gained, so that it may usually be very readily repelled 
and the head brought into position, so that the extraction may 
finally take place in a somewhat normal manner. 

Some operators advise, instead of subcutaneous amputation of the limb, 
the amputation of the head and neck, which we have described on page 644. 
We regard the amputation of the limb as an easier, quicker and safer opera- 
tion. Should the fetus be emphysematous, it is also more eificient. If the 
fetal body is normal, the accomplishment of either operation is efficient. 

4. Hysterotomy, or Caesarian section, is uncalled for in 
the larger domestic animals, and usually in the sheep and goat. 
In the smaller animals, where the correction of the deviation 
fails, and embryotomy is not available because of the narrowness 
of the passages, Csesarian section, as described on page 663, is 
the only recourse, and offers a fair prognosis if undertaken at the 
proper time and under proper conditions. 

2. Downward Deviation of the Head Between the 
Anterior Limbs. 

In describing the lateral deviation of the head, we did not state 
the very evident fact that such a deviation may not be direct but 
may be variably oblique upward or downward. Such devia- 
tions from the direct lateral line are not materially important, 
and offer nothing unusual for our consideration. In other in- 
stances there is a downward deviation, in which the head passes 
downwards between the two anterior limbs. 

We have stated, in considering the normal attitude of the fetus 
in the uterus, that it rests with its head and neck bent ventral- 
wards, with its chin in close proximity to or resting upon the 
sternum. It is easy to understand that in some cases the head 
may remain in this position, and the two anterior limbs become 
extended and enter the pelvic canal. The head, passing down 
between the anterior limbs, is tightly held in that position, be- 
cause the limbs are firmly pressed together over the back of the 
neck. 



Downward Deviation of the Head 771 

There occur variations in the degree of the deviation, as in 
other cases, but they largely arrange themselves into two groups. 
The first group includes those of a minor character, in which, 
when the fetus advances along the birth canal, its nose catches 
against the pubic brim. As the fetus is pushed along, there is a 
constant tendency for the nose to turn more and more downward 
and backward, while the head becomes sharply flexed upon the 
neck and the poll passes into the pelvis, to constitute what is 
sometimes known as the poll presentation. 

From this position it has been assumed by some that the devi- 
ation may become more and more accentuated until it reaches 
that degree where the head passes completely downward between 
the legs. A study of the circumstances under which the devia- 
tion occurs tends to throw serious doubt upon this view. When 
the limbs are advanced in the pelvic canal, they are necessarilj' 
confined quite closely to each other, and it is only during the 
early stages of advancement, before the feet have yet approached 
the vulva, that the muzzle of the foal or calf can well drop down 
between the two anterior feet and become jammed against the 
pubic brim. As the two limbs advance further and further, they 
become applied more and more closely to each other, so that it 
would be highly improbable for the head of the fetus to pass com- 
pletely down between them to occupy a position beneath them. 
We hold, therefore, that the two positions are not differences of 
degree, but are fundamentally different in origin, and that one 
does not pass into the other by imperceptible gradations. 

The diagnosis by manual exploration is comparatively easy. 
In the first instance the head is found lying upon the anterior 
limbs, with the poll directed more or less upwards and forwards, 
while the nose projects down between the limbs and is caught 
against the pubic brim. In the second instance the head at first 
cannot be felt, but the limbs seem to be pushed somewhat apart 
as they near the chest. Careful manipulation will reveal the fact 
that the top of the neck or the mane disappears almost straight 
downward from the top of the withers, to finally recurve back- 
ward. By reaching around underneath the anterior limbs and 
fetal chest, some portion of the head will most likely be reached 
and identified. 

The handling of the downward deviation of the head offers 
some variations according to type. 



772 Veterinary Obstetrics 

1. Mutation is usually applicable in those milder cases where 
the nose is caught against the pubic brim, and the correction of 
the deviation constitutes the most rational and economic proced- 
ure. In such cases it is not difficult to repel, as described on 
page 595. The operator should correct the deviation by insert- 
ing his hand between the pubic brim and the muzzle of the fetus, 
and, grasping the latter in the palm of his hand, lift it over the 
pubic brim and extend it in the pelvis. The case is then to be 
proceeded with in the ordinary manner of normal parturition. 
When the head has passed completely down between the legs, 
correction of the deviation may prove highly difficult or impos- 
sible. It is essential to so far repel the fetus that the carpal joints 
pass into the abdomen and permit the limbs to part sufficiently to 
allow the head to pass up between them and resume its normal 
position. 

When the fetus has been sufficiently repelled to permit the 
carpal joints to be flexed and parted, the lower jaw may be corded 
as described on page 637, grasped with the hand or secured by 
a hook in the orbit, and lifted upwards between the legs. 

In the smaller animals the correction of the displacement is to 
be undertaken in the same manner as we have just related for the 
lateral deviation. 

2. Forced extraction. Tapken strongly advises forced ex- 
traction in those cases in the mare where the nose of the foal is 
.caught against the pubic brim, if there is any hope that the fetus 
is alive. He believes that he thereby greatly advances the inter- 
ests of the foal without materially injuring those of the mother. 
However, it is very rare that the foal is alive when the veteri- 
narian reaches the case, and there is rarely, if ever, any reason 
for precipitancy. 

3. Embryotomy. Where the head is completely deviated 
downward and the two anterior limbs are closed over above it, 
and a reasonable effort demonstrates that the replacement of the 
head is improbable, or if it will apparently prove very difficult 
and the fetus is dead or comparatively valueless, we should pro- 
ceed at once with embryotomy. We prefer to remove one ante- 
rior limb subcutaneously, according to the technic on page 645, 
by which process we relieve the incarceration of the head and 
permit it to be readily brought into position, after which the ex- 
traction occurs in the ordinary way. 



Interlocking of the Fetal and Maternal Pelves 773 

3. Upward Deviation of the Head. 

The upward deviation of the head is exceedingly rare in prac- 
tice, and is due to some accidental misdirection while the fetus 
is passing along the birth canal. In most animals, and especially 
in the foal, a primary upward deviation is so unstable that the 
head is very liable to drop off to one side and, revolving some- 
what upon its long axis, assume a more or less lateral displace- 
ment. Owing to the anatomical peculiarities of the head and 
neck, this displacement is perhaps most frequently observed in 
carnivora, where it may constitute a very serious obstruction to 
birth. 

The diagnosis is not readily made in the smaller domestic ani- 
mals. In the larger ones, where manipulation is practicable, the 
obstetrist finds upon the insertion of his hand that, though the 
position isdorso-sacral, the head is not readily grasped or touched, 
and that the trachea of the fetus, freely exposed and presenting 
toward the pelvic inlet, emerges from the chest and turns upward 
and then backward to disappear along the sacrum of the mother. 

The indications are analogous to those already related under 
lateral deviation. First we should consider the question of re- 
pulsion and correction of the deviation by methods already de- 
scribed. Second, before exhausting the strength of the opera- 
tor or of the patient, if the replacement is diflBcult, or threatens 
to be futile, embryotomy is to be recommended, and should be 
carried out upon the same basis as in the lateral deviation. 

Caesarian section, page 663, necessarily constitutes a valu- 
able and available method for handling this deviation in the 
carnivora, where the hand of the operator cannot be inserted 
along the genital passages to correct the vicious position. As in 
other cases of hysterotomy, the operation should here be under- 
taken early, before the patient has become exhausted or the 
fetuses have perished and become emphysematous, and especially 
before the genital passages have been lacerated and infected in a 
vain effort to bring about extraction by other means. 

d. Dystokia in the Anterior Presentation, 
Due to the Hips. 

Interlocking op the Maternal and Fetal Pelves. 

It not infrequently occurs, especially in the cow, that birth 
has proceeded with more or less facility, with the fetus in an ap- 



774 Veterinary Obstetrics 

parently normal position, until the anterior portions have passed 
beyond the vulva and the hips of the fetus have reached the 
pelvic inlet, when the progress is interrupted and the fetus re- 
fuses to move, even under vigorous traction. The interpretation 
of this condition varies with different obstetrists. 

Some hold that the dystokia occurs because the two stifles are 
in a state of abduction and thus, standing apart, catch upon the 
pelvic margin and stop the progress of the fetus. It is difficult 
to conceive of the possibility of such a condition, because there 
is nothing to maintain such abduction, but all the expulsive 
forces tend to promptly and effectively overcome it. 

According to our interpetation of this difficulty, the conditions 
are as we have depicted in Fig. 109, page 650, and consist es- 
sentially of the interlocking of the pelves of the fetus and mother 
in such a way that, if the traction is applied in a somewhat unfa- 
vorable upward direction, the incarceration is emphasized instead 
of being overcome. 

During its development the embryo lies in the form of the seg- 
ment of a circle, and the ventral surface of the body is main- 
tained in a somewhat concave form. When the fetus begins its 
passage through the birth canal, it maintains this curved form 
until it has been completely expelled from the vulva. If this 
direction becomes interrupted, according to our observation, the 
pelvis of the fetus may become interlocked with that of the 
mother. 

If, when the chest of the fetus is passing through, or has 
passed beyond the vulva, traction is directed upward instead of 
downward, the external tuberosities of the fetal ilia are thrown 
upward, and the prepubian tendon of the fetus, being rendered 
tense, draws the fetal pubis forward, flexes the fetal pubis upon 
the sacrum and increases the transverse diameter between the 
supero-external tuberosities of the fetal ilia. 

The tension upon the Jjrepubic tendon, by advancing the fetal 
pubis, increases greatly and dangerously the perpendicular 
diameter of the fetal pelvis. Normally the fetal pelvis leaves the 
spinal column at an acute angle, and, if traction is exerted on 
the spine, this angle is increased, the ilial tuberosities are low- 
ered, and the ischia and pubis pass backwards and upwards. If 
the traction is instead applied to the pubis through the prepu- 
bian tendon, the angle is reduced and the ilial shafts approach 



hite7-locking of the Fetal and Maternal Pelves 11^ 

the perpendicular to the fetal spine. The error in the direction 
of traction causes the fetal ilia to become firmly lodged against 
the anterior border of the maternal ilia, and. the more violent the 
traction, the firmer the interlocking. 

When the fetal pelvis is large and the external ilial tuberosi- 
ties prominent, the hips may offer serious resistance in passing 
the pelvic inlet, even without the complication of misdirected 
traction. 

With misdirected traction we have twice seen cows tied firmly 
by the head to a post, with one or two horses hitched to the 
fetus and pulling their utmost in an attempt to bring away the 
calf, but without avail. 

The symptoms and diagnosis of this form of dystokia require 
but little consideration. The fetus, possibly rather large, gen- 
erally offers in the normal anterior presentation, and advances 
somewhat slowly until the hips have reached the pelvic inlet, 
when the progress is stopped and the fetus cannot be advanced 
by traction so long as it is applied in a direct line, parallel to the 
long axis of the body of the mother or somewhat upwards. If 
the operator can succeed in inserting his hand along the fetus 
into, the uterus, he will find that everything is apparently normal, 
except that the pelvis of the fetus is firmly wedged against that 
of the mother and seems immovable. We know of but one con- 
dition from which we need to differentiate it, and that is the 
double monstrosity known as pigodidymus aversus. Fig. 129. 

The indications in this form of dy.stokia are : 

1. The Application of Traction in the Proper Direction. 
When a fetus is advanced without serious difficulty until it has 
reached the hips, and is in every way normal, there is no good 
reason why its extraction should not be readily completed, if care 
is taken to apply the traction directly downward toward the feet 
of the mother, according to the technic given on pages 586 and 
640. Some suggest release by partial rotation. 

2. Embryotomy. Failing to bring about extraction under 
moderate force, the obstetrist should at once resort to embryot- 
omy, consisting of the destruction of the pelvic girdle, as already 
described on page 649. 



7/6 



Veteritia?-v Obstetrics 



e. Dystokia in the Anterior Presentation due to the 

Forward Extension oe the Hind Limbs 

Beneath the Fetal Body. 

In the mare, and possibly in other animals, we occasionally 
encounter a fetus presenting anteriorly, with the anterior limbs 
and head in an approximately normal position, and the two 
posterior limbs thrust forward in extreme extension beneath the 
body of the fetus, so that the two hind feet are lodged just in 
front of the maternal pubic brim, or have passed some distance 
along the pelvic canal. This places the fetal body in such a 
position that its progress becomes blocked when the neck or chest 
has appeared at the vulva. 




Fig. 134. FoRw.\RD Devi.\tion of Posterior Limbs 
IN Anterior Presentation. (St. Cyr.) 

The nature of this presentation suggests to one that of the 
ventral transverse presentation, in which all four feet are present, 
but the head is wanting, whereas in this case all four feet and 
the head offer at the inlet, and become more or less engaged in it. 

The fetus is ordinarily in the dorso-sacral position, with the 
proper relations existing between the two anterior limbs and the 
head and neck. However, when it has advanced sufficiently for 
the fore feet and nose to show at the vulva, its further progress 
becomes blocked. In.serting the hand beneath the body of the 
fetus, the operator encounters one or both posterior feet, either in 
the pelvic canal or just anterior to the brim of the pubis, where 
they are easily recognized, their soles directed downwards. The 
spinal column is jammed hard against the maternal sacrum. 



Forward Extension of Posterior Limbs 777 

The prognosis is extremely unfavorable. Next to bi-cornual 
pregnancy, this is one of the most dangerous positions of the 
fetus encountered in the mare. The fetus is doubled up in 
such a manner as to cause very severe pain and violent straining, 
constantly threatening serious or fatal injury to the mother. 
The position offers unusual opportunity for damage by empirics, 
and invites violent traction by laymen without knowledge of the 
serious results which are almost sure to follow. When the two 
posterior feet are lodged against the brim of the pubis, the danger 
is perhaps greater than when the hind feet are well advanced in 
the pelvis, because the expulsive efforts of the mare, or traction 
applied by attendants, tend to force the two posterior feet through 
the floor of the uterus. It is also a position in which the layman 
and empiric may undertake embryotomy, and in one case at- 
tended by us they had performed detruncation through the 
dorsal region, but had failed to protect the genital organs from 
the sharp bones which they had left. As a consequence, the 
vagina was very badly lacerated and a chronic vagino-cystitis 
followed, from which the mare never recovered, although she 
survived. 

The method of handling varies greatly in the hands of different 
obstetrists. 

I. Mutation. Some advise the adjustment of the misplaced 
members, but we find no data to show in what proportion of cases 
such a plan may succeed. The directions given are to repel the 
two hind feet as far as possible into the uterine cavity and abdo- 
men, and then by traction to bring the fetus away. It must be 
evident that it is only in very favorable cases that such an oper- 
ation can succeed in the mare. With the anterior portion of the 
fetus and its body impacted firmly in the pelvic canal, the oper- 
ator cannot reach very far into the abdominal cavity, and cannot 
expect to repel the two posterior feet to any very great degree. 

The character of the position generally excludes all possibility 
of repelling the head and body of the fetus, and if the hind limbs 
are very far advanced in the pelvic canal it would seem impossi- 
ble to effectively repel them. Even when repulsion has suc- 
ceeded to a degree, it is impossible for the operator to know if 
the two hind feet rest in a safe position where they may turn 
backward as the fetus moves forward, or not. It seems to us, 
from our clinical observation, that there would be constant danger 



778 Veterinary Obstetrics 

of the hind feet being thrust through the floor of the uterus 
while traction is being applied to the anterior portion and the 
hips are advancing and passing over the bent limbs. 

We do not consider adjustment of the deviated posterior limbs 
safe, practicable or advisable in the mare. Such an operation 
may be wholly feasible in the cow, but dystokia of this form has 
not been observed bj' us in this animal. The deviation is 
generally observed in the mare. 

2. Forced Extraction. Other obstetrists advise forced ex- 
traction. What success they have attained we cannot determine 
from the literature before us, but it would appear that the posi- 
tion is one which renders this operation specially dangerous. 
The plan of forced extraction is to secure the two hind feet with 
cords, advance them well under the body of the fetus, and then,, 
applying powerful traction simultaneously upon the two hind 
limbs and the head, bring it away entire. Such a plan of delivery 
necessarily draws the pubis forward and forces the pelvis into 
that unfavorable position we have already described as "Inter- 
locking of the Fetal and Maternal Pelves." 

3. Embryotomy constitutes, according to our view, the most 
desirable and rational method for handling these cases in the 
mare. In performing embryotomy, our chief operation would 
be that of detruncation, page 648, repulsion of the hips, and 
conversion of the fragment into the posterior presentation. 

In all cases of dystokia in this position, an unfavorable prog- 
nosis should be given, whatever the method of handling. Be- 
fore beginning his operation, the veterinarian should determine as 
far as possible if any rupture of the uterus has been caused by 
the two posterior feet, or if they have wounded the large uterine 
vessels of this part, causing serious hemorrhage. 

In our practice, one mare died from uterine hemorrhage while we were 
preparing to attempt delivery, although the case was a very recent one and 
had not been greatly tampered with. 

In another case, to which we have already alluded, the owner and his 
neighbors had bisected the fetus through the thorax and left the vertebrae 
and ribs freely exposed, and had lacerated and torn the vulva and vagina in 
a verj' repulsive manner, so that, although we succeeded in detruncation at 
the proper point and the removal of the remnant of the fetus, the lacera- 
tions which had been caused by the owner were followed by a severe and 
chronic infection, which not only involved the vagina and vulva, but ex- 
tended into the bladder, causing a severe chronic purulent cystitis, from 
which recovery was very tardy and incomplete. 



Forward Extension of Posterior Li^nbs 779 

We were called to attend a vigorous young mare suffering from this form 
of dystokia. The case was recent and had not been meddled with. Delivery 
by detruncatiou was prompt and easy. The mare died two days later from 
gangrene of the vulva and vagina. 

In a fourth case a foal was found one morning incarcerated in this 
position. Apparently the dystokia had existed much of the night. The 
delivery was easy. Gangrene of the vulva with sloughing occurred, followed 
by vulvar constriction of such a degree that copulation was not possible. 

We have not had a satisfactory recovery in this form of dys- 
tokia. 



II. DYSTOKIA OF THE POSTERIOR PRESENTATION. 

I. DORSO-ILIAL AND DORSO- PUBIC POSITIONS. 

When considering the normal course of birth we had occasion 
to observe that a fetus presenting posteriorly, especially in the 
larger domestic animals, may pass quite readily through the 
pelvic canal, so long as it is in the dorso-sacral position ; but, 
whenever it deviates to any great extent from this, its passage 
becomes more or less difficult or impossible, depending largely 
upon the size of the fetus as related to the dimensions of the 
channel through which it must pass. 

The dorso-pubic position is the most unfavorable, because, 
owing to the curvature of the body of the fetus, the hind feet 
project upward against the roof of the vagina, so that they may 
readily become engaged in the vaginal walls and cause more or 
less obstruction to the progress of the fetus, and at the same 
time greatly imperil the integrity of the soft parts of the mother. 
When the fetus is lying upon its back, its buttocks drop down 
in front of the pubic brim in such a position that it is exceed- 
ingly difficult for the contraction of the uterus and abdominal 
walls to lift it up over the pubis and cause it to enter the pelvic 
canal. 

The indications in these positions are to bring about an ad- 
justment by rotating the fetus upon its long axis, as described 
on page 632. 

Some obstetrists hold that the fetus may pass through the 
canal somewhat easily when in the dorso-ilial or dorso-pubic po- 
sition, and that, in either of these positions, it may often be 
forcibly extracted without serious peril to the mother, but ac- 
cording to general experience such positions offer more or less 
serious obstacles to delivery, especially in the calf and the foal. 

If the fetus is very large, the amount of traction necessary to 
bring it away passes the limit of safety ; if the amount of force 
required is not great it is usually very easy to bring about rota- 
tion and delivery by the more natural method. Thus, forced 
extraction has a very limited application in this form of dystokia. 

Embrj otomy might be demanded in very rare cases, where, 
owing to firm impaction in the pelvic canal, rotation becomes 
impossible and forced extraction unsafe. 
780 



Flexion of the Hind Legs at the Tarsus 781 

2. Flexion of the Hind lyiMBS at the Tarsus. 

We meet occasioually, especially in the mare and cow, with 
dystokia due to the tarsal articulations becoming flexed and 
either entering the pelvic canal or becoming caught just in front 
of the pubis. This displacement constitutes a formidable obstacle 
to the expulsion of the fetus, because it necessarily involves the 
flexion of all the articulations of the limb, and consequently 
greatly increases the diameter as measured from the fetal sacrum 
down through the folded limb. The femur is flexed upon the 
pelvis, the tibia upon the femur, the metatarsus upon the tibia, 




Fig. 135. Retention of Posterior Limbs at 
THE Tarsus. (Franck). 

and the phalanges upon the metarsus. We cannot extend one 
of these articulations completely until the others are ready to be 
simultaneously extended, and the folding of the limbs in this 
manner quite effectively prevents the passage of a fetus of normal 
dimensions through the pelvic canal. 

The diagnosis is comparatively easy. Upon inserting the 
hand, the operatorinaj' first touch the tail, or the ischiatic tuber- 
osities, lyying just beneath and in front of the pubic border, 
there is recognized the summit of one or both hocks. In some 
cases the flexed hocks extend into the pelvic canal. The fetus 



782 Veterinary Obstetrics 

is thus lying iu the position of ordinary sternal recumbency, with 
the hind feet closely doubled immediately beneath the body. 

The cause of this displacement is not far to seek. In discuss- 
ing the normal position of the fetus in the uterus, we have noted 
that it usually lies with its hind legs folded beneath its abdomen. 
When parturition occurs, the limbs should, under normal condi- 
tions, become extended, so that in a posterior presentation the 
most advanced part should be the two hind feet. When this ex- 
tension fails to take place, and the fetus is forced toward the 
pelvic inlet in the position in which it has previously lain, the 
points of the ossa calces naturally become caught against the pubic 
brim, or advance for a short distance in the pelvic canal, and stop 
further progress in the expulsion of the fetus. 

Handling, i. The correction of the deviation should in all 
cases be undertaken if, in the judgment of the obstetrist, it can 
be properly accomplished. The overcoming of the deviation 
consists first in the repulsion of the fetus obliquely forward and 
upward, as described on page 595. The mother should prefer- 
ably be in the standing position, with the hind parts elevated. 
If unable to rise, she should be placed in lateral recumbency, or 
sometimes still better, in the dorsal position, still applying the 
rule of keeping the posterior portions of the mother higher. 
When the repulsion has been accomplished, the extension of the 
limbs is to be carried out as described on page 636. 

2. Forced extraction has been suggested by some operators, although 
neither its advantages nor safety have been clearly demonstrated. As a 
general rule the so-called forced extraction in this position really involves 
partial embryotomy by the severing of the ten do-Achilles, which, by permit- 
ting dorsal flexion at the fetlock, ameliorates the dystokia. In our judg- 
ment forced extraction is never necessary, and rarely if ever justifiable, even 
with the severing of the tendo-Achilles. 

3. Embryotomy occasionally becomes necessary or desirable. 
In case of a very large foal, or when the foal or calf is dead and 
emphysematous, and especially in those cases where the patient 
is unable or unwilling to stand, it may be impossible, or at least 
impracticable, to adjust the position, and consequently embry- 
otomy must be performed. 

Embryotomy in these cases is very simple, consisting merely 
of the amputation of the foot with the chisel, through the lower 
portion of the tarsus, as described on page 651. 

4. Caesarian section, page 663, may become necessary iu the 



Complete Reientio7i of the Posterior Limbs 



783 



smaller domestic animals, where the adjustment of the deviated 
limbs or embryotomy is not available. 

3. Complete Retention of the Posterior Limbs. 
Breech Presentation. 

The breech presentation may be met with in any of the domes- 
tic animals, and probably acquires its greatest significance in the 
mare, where it constitues a very formidable cause of dystokia. It 
differs from the preceding deviation in that, instead of being 




Fig. 136. Breech Presentation. (St. Cyr. ) 

flexed at the hocks, the posterior limbs are flexed upon the 
pelvis, beyond which each joint is in rigid extension and the 
limbs are thrust forward beneath the abdomen and chest of the 
fetus. The causes are identical with those of the preceding, and 
probably in many cases complete retention follows flexion at the 
tarsus. The flexed tarsus becomes caught against the brim of 
the pubis, and the expulsive efforts of the mother, pushing the 
fetal body along, cause the ossa calces to glide downward and then 
forward, and the tarsus to become extended, until finally the en- 
tire limb is pushed forward beneath the body. The operator, upon 
examining the case, usually meets first with the tail or buttocks 



784 Veterinary Obstetrics 

of the fetus, and in many cases can only touch the tibia or other 
portion of the limb with very great difficulty. Sometimes no 
part of the hind limb can be grasped or recognized until after re- 
pulsion has taken place. 

1. The adjustment of the deviated limbs is first of all indi- 
cated. The fetus should be repelled, as described on page 595,. 
after which the tibia or metatarsus, as may be available, should 
be secured by means of cords, as described on page 579. By 
continuing repulsion, the position is to be converted into a hock 
presentation, after which the further handling of the case is iden- 
tical with that position which has already been described. 

2. Forced extraction has been advised by some operators in 
these cases. As to how successful they have been our veter- 
inary literature is not very clear. They suggest a variety of ways 
for bringing about forced extraction. Some recommend that a 
cord with a running noose be passed around the loins of the fetus^ 
and secured, or rather that the cord be passed around each of the 
thighs and then passed through the noo.se at the top of the back, 
so that the loins of the fetus are secured and the operator is 
enabled to apply any degree of traction which may be desired. 

Others would apply traction by means of sharp hooks deeply 
imbedded in the flanks, like the flank hooks of Harms. Yet other 
obstetrists would incise the perineum of the fetus and, inserting 
the hook through the fetal pelvis, engage it in the obturator 
foramen or in front of the pelvis, and exert traction in this way. 

While forced extraction may be somewhat easier for the ob- 
stetrist, we do not consider it warranted by modern surgical prin- 
ciples. We have at no time found any need for applying forced 
extraction. 

3. Embryotomy offers the most valuable method for over- 
coming this form of dystokia, especially in the mare, in all those 
cases where adjustment is impossible or difBcult. Whenever the 
fetus is comparatively large or is dry or emphysematous, or for 
any other reason it is exceedingly difficult or impracticable to 
bring about an adjustment of the position, embryotomy is highly 
commended, and should be undertaken promptly, before the ope- 
rator and patient have become exhausted in fruitless endeavors.. 
Various forms of embryotomy have been recommended by differ- 
ent writers, but we greatly prefer the intra- fetal amputation of 
the two posterior limbs, as described on page 653. Others prefer 



Complete Retention of the Posterior Limbs 785 

to amputate the limbs extra- fetally, with the knife, Persson's 
saw, or the Pflanz embrytom. 

4. Caesarian section, as described on page 663, is sometimes 
necessary in the smaller animals, like the sow and bitch, but is 
uncalled for in the cow and mare because embryotomy is always 
readily available. 



50 



III. TRANSVERSE PRESENTATIONS. 

a. Dorsal Transverse Presentation. 

Transverse presentations are virtually confined to the unipa- 
rous animals, and among these the overwhelming majority occur 
in the mare. The fetus usually presents ventrally, except in 
those cases we have already described as Bi-cornual Pregnancy 
on page 716. 

When the dorsum of the fetus offers at the pelvic inlet in the 
right or left cephalo-ilial position, the position is usually uncom- 
plicated by any further deviation, so that, when the operator 
inserts his hand, it comes at once into contact with the dorsal 
surface of the fetus, which is easily recognized. By extending 
the hand to the right or left, he may palpate and recognize the 
hips or the shoulders and neck. As a general rule the operator 
does not come in contact with the head or any of the feet, but 
only with the body, although in rare cases one or more of the 
feet may be more or less misplaced in their general relation to 
the body of the fetus, and project in such a manner that they 
may be felt or grasped by the operator. In one case in our ex- 
perience, one hind leg passed backward over the fetus into the 
pelvic canal. 

The causes of transverse presentations are not well defined. 
Most obstetrists hold that they are acquired positions, occurring 
during labor ; but, as we have related, page 716, the fetus of the 
mare occasionally develops equally in the two uterine cornua, in 
a transverse position. In the anomalous development which we 
have described, the fetal body revolves upon its long axis in order 
to attain a stable position. 

We do not know that all fetuses developing transversely in 
the mare undergo this rotation, and we can readily conceive it as 
being wholly possible that no rotation should occur, in many 
cases, and consequently that the fetus may develop transversely 
and, without rotation, present transversely at the time of partu- 
rition. 

Handling. Version, as described on page 634, is usually 
the best and most effective method of handling. In almost every 
case it succeeds well. Should this fail, it may be necessary to 
perform detruncation in the lumbar region. The detruncation 
is to be accomplished chiefly with the chisel, severing first the 
786 



Transverse Presentations 



7&7 



spinal column. The soft parts may be most conveniently sev- 
ered with the finger knife. Evisceration, page 648, should fol- 
low. The posterior half may be secured by means of a rope noose 
about the lumbar vertebrae, or by hooks or cords applied inside 
the pelvis. 

It may prove necessary to extend the embryotomy to include 
the destruction of the pelvic girdle, pages 661 and 649. In 
other cases, the posterior half of the fetal body may be repelled, 
and converted into a posterior presentation. 




Fig. 137. Dorsal Presentation. (Franck). 

The anterior half is to be managed in a similar manner. After 
evisceration it may be desirable to sever the ribs, page 656, so 
as to permit the fetal chest to collapse. The remnant may now 
be extracted by securing the dorsal vertebrae by means of a cord 
and exerting traction upon it. 

In some ca.ses it may be practicable or preferable to convert 
the anterior half into the anterior presentation. 

In one instance occurring in our practice, due to abortion in 
a mare, the fetus was in the dorsal transverse presentation, with 
its upper hind leg extended over its back into the pelvic canal. 
The leg could not be returned into the uterine cavity, and con- 
sequently detruncation was effected, after which it was easy to 
convert the posterior half into a posterior presentation, and the 
two pieces were readily removed. 



788 Veternary Obstetrics 

b. Ventral Transverse Presentation. 

Most fetuses in the transverse presentation offer at the pelvic 
inlet by their ventral surfaces. The head of the fetus is retained, 
all the feet offer in, or are somewhere near to, the pelvic inlet, and 
the fetus lies upon its side, more or less transverse to the spinal 
axis of the mother, with the fetal head resting in the region of 
one or the other of the maternal ilia — right or left cephaloilial 
position. 

Symptoms. In most instances some or all feet appear at or 
near the vulva, but no essential progress is made in the expul- 
sion of the fetus, although the animal may make violent expul- 
sive efforts, and neighbors and empirics may apply force. 

In a large proportion of the cases in the mare, wrj'-neck is 
present. If the wry-neck is to the right the fetus usually lies 
upon its right side, and if to the left upon its left side, so that the 
head in a large proportion of cases is entirely out of reach, which 
in many respects is fortunate. Upon inserting the hand, the 
obstetrist usuallj^ meets with, and can identify, all four of the 
limbs. In some cases it may be exceedingly difficult for him to 
differentiate between the different members, so badly are they 
entangled with each other, and so tightly impacted in the pelvic 
canal. 

This form of dystokia is quite favorable for the mare, because 
the owner or empiric is usually balked at once in any effort to 
meddle with the case, and must consequently await the arrival 
of the veterinarian. Even more or less violent traction upon the 
fetus, as a general rule, produces little harm, because its position 
is such that any moderate force applied to the feet cannot wedge 
the fetal body in the pelvic inlet or force any projecting portion 
of the fetus against the soft parts of the mother. 

Handling, i. Version. In the cow it may be practical and 
advisable to attempt adjustment without embryotomy, because 
the feet and legs are shorter and more pliable than those of the 
foal. If it is decided to perform version of the fetus, the two 
posterior limbs are to be corded at the pastern, and the two 
anterior limbs pushed away forward as far as the operator can 
reach, while an assistant advances the posterior limbs by exert- 
ing traction upon the cords, as described on page 634. The 
operator thus converts a transverse into a posterior presentation, 
after which the delivery is completed as such. 



Ventral Transverse Presenlation 789 

2. Embryotomy. In the mare we regard embryotomy as be- 
ing simpler and safer than version, without generally involving any 
great amount of labor upon the part of the obstetrist. Embry- 
otomy in these cases consists of the subcutaneous removal of the 
two anterior limbs, as described on page 645, followed by version 
of the fetal remnant, which is to be brought about by repelling 
the chest and applying traction to the two posterior limbs, in or- 
der to convert the transverse into a posterior presentation. 

This position is subject to a variety of complications, which 
may tax the skill and endurance of the operator. In the typical 
case in the mare, which we have described above, it requires only 
about one hour or one and a half hours to perform embryotomy 




Fig. 13S. Ventrai, Present.\tion. (Franck). 

and deliver the fetus as outlined. An expert operator may even 
accomplish the task in much less time, but in the presence of 
certain complications it may require very much more time. 

In one of my cases all four teet of the fetus had already passed through 
the vulva, and the four large, bony limbs were tightly impacted in the pelvic 
canal, completely filling it, so that it was only with difficulty that the arm 
could be inserted alongside or between them. I could reach neither of the 
shoulders to amputate subcutaneously, but was forced to amputate one at 
the elbow joint, and the other with difficulty at the scapulo-humeral articu- 
lation, but these amputations served my purpose, and permitted delivery 
after some five or six hours of fatiguing labor. The case was further com- 
plicated by the viciousness of the mare, which persistently fought by kick- 
ing, striking or biting at any one within her reach, so that it became neces- 
sary to cast her and securely tie all four feet. The recumbency, with the 



790 Veterinary Obstetrics 

cramped position of all four feet, induced extraordinary pressure upon the 
abdomen and greatly restricted the room for the work. Nevertheless she 
made a good recovery. 

In another instance the two anterior limbs were well advanced in the pel- 
vis, with the feet protruding beyond the vulva, while the two hind feet were 
jammed across the pelvic inlet. The upper hind foot crossed above the up- 
per forefoot in front of the pelvic inlet, and the toe was firmly caught in 
front of the shaft of the maternal ilium, while the hock lay immovably fiixed 
against the iliac shaft on the other side. The lower hind foot passed be- 
tween the two anterior limbs, and was otherwise engaged in the same way 
as the upper hind foot. 

It was impossible to repel the fetus, and equally impossible to reach the 
uppermost shoulder to amputate the anterior limb, because of its being 
crossed by the metatarsus. With the chisel, we therefore amputated the up- 
per hind foot through the lower part of the tarsus, removed the foot, and 
secured the stump above the os calcis with a cord. The upper fore-leg was 
then removed subcutaneously. Next the lower hind foot was amputated at 
the tarsus, in the same manner as the first one, and the stump was secured 
with a cord. Finally the lower anterior limb was amputated subcutaneous- 
ly, after which the chest was repelled, while traction was applied to the 
stumps of the amputated hind limbs, and the remnant of the fetus was con- 
verted into a posterior presentation. 



PATHOLOGY OF THE PARTURIENT OR PUERPERAL 
STATE. 

Grouped about the act of parturition, there is a highly inter- 
esting and important series of accidents and diseases of the mother, 
which require close study upon the part of the veterinary obstet- 
rist. They occur in all animals, although one or another disease 
or accident may be far more frequent in one species than in an- 
other. These diseases, injuries or infections usually have some 
definite time at which their foundation is chiefly laid, but there 
are wide variations as to the exact time of the advent of the 
symptoms. In some instances they may occur before parturition; 
in others, during or after that act. Many of them pass by im- 
perceptible gradations from one into another, which tends to ren- 
der their classification somewhat difficult, and subjects any plan 
which may be suggested to certain objections. For con- 
venience, this group of affections may be divided into five 
classes : Pathology of the Placenta ; Wounds and Injuries of the 
Genital and Neighboring Organs ; Puerperal Infections ; Partu- 
rient Eclamptic Diseases ; and Diseases of the Mammse. 

I. PATHOLOGY OF THE PLACENTA. 

Retention of the fetal Envelopes. Retained 
Afterbirth. 

In dealing with the question of birth, we have already had oc- 
casion to allude on page 516 to extra resistance of the chorion, 
which, it has been claimed, sometimes imperils the life of the 
fetus ; on page 742, to adhesions between the fetal membranes and 
the fetus as a cause of difficult labor ; and on page 525, to the rup- 
ture of the chorion and its expulsion with the other membranes, 
in advance of the fetus, leading thereby to fetal death. These 
conditions are rare, and relatively unimportant from an economic 
standpoint. 

Retained placenta constitutes one of the most common and 
serious maladies among the diseases of the puerperal state, espe- 
cially in the cow. In considering normal birth, we have noted 
that, as a consequence of that act and following closely upon 
the expulsion of the fetus itself, there should normally occur a 
separation of the fetal placenta from that of the mother and an 
791 



792 Veterinary Obstetrics 

expulsion of the fetal membranes from the uterus. If they remain, 
they inevitably undergo decomposition and cause more or less 
serious disease. When the fetus has been removed or has ceased 
to live, and the passage of blood through the umbilic cord has 
ceased, these membranes become essentially foreign bodies, highly 
subject to infection, which more or less seriously involves the 
uterus and the animal system as a whole. 

A study of the placentse of the domestic animals shows that 
the intimacy of contact between fetal and maternal placentae 
varies greatly in the different species. The placental tufts are 
very much longer and more complex in ruminants than in other 
domestic animals. In ruminants the placental attachments are 
not uniform over a large area, as in the mare and sow, but they 
are concentrated upon certain well-defined areas, where their 
attachment is all the more complex. It would at once be sus- 
pected, after a study of the anatomy of the placentse of various 
domestic animals, that ruminants, with their highly complex 
cotyledonous placentse and very complex placental villi, would 
be far more subject to retention of the fetal membranes than is any 
other animal. This suggestion, however, holds true for but one 
member of the group, the cow. Retained placenta may almost 
be said to be a disease of the cow, so far as the domestic animals 
are concerned. While the condition is met with in all domestic 
animals, and acquires importance in mares, there is no such 
number of instances in any other domestic animal, or in all others 
combined, as in the cow. See Fig. 97, p. 361 and Fig. 139, p. 802. 

It is difScult to deiine in exact terms what constitutes retained 
placenta. The line between the normal and abnormal duration 
of retention of the placenta, after the expulsion of the fetus, 
constantly vacillates according to species and individual, so that 
the term is largely a comparative one. In the mare the chorion 
usually separates from the uterus within 10 to 15 minutes after 
the expulsion of the fetus, and if it remains over 30 minutes it 
might be very properly considered abnormal, although in all 
probability it may yet separate and come away spontaneously 
after a further trifling delay, and the case pursue an apparently 
normal course. 

In cows the fetal membranes usually do not become detached 
so quickly. In a large proportion of cases they still remain at- 
tached to the cotyledons after one-half to one hour, and, not at 



Retained Placenta in the Cow 793 

all rarely, in cases which are apparently normal, they remain from 
4 to 12 hours or even more, before becoming detached and drop- 
ping away. However, if they remain for a longer period than 10 
to 12 hours after the expulsion of the fetus, especially if the latter 
has been carried for the full term, most obstetrists would regard 
the further retention as abnormal. 

In the smaller ruminants, the ewe and goat, the placenta is 
usually expelled with more promptness and uniformity than in 
the cow. 

In multiparous animals it is the rule, if not a necessity, that the 
placenta of each fetus shall become expelled prior to the expul- 
sion of the next fetus from the same cornu, and the last fetus is 
almost immediately followed by the expulsion of its membranes. 

I.. Retained Placenta in the Cow. 

Although, among all the domestic animals, the cow is by far the 
most subject to retained fetal membranes, the causes of such re- 
tention have not been made wholly clear by veterinary writers, 
and in fact comparatively little investigation has been made, 
with a view to a scientific explanation of the pathologic condi- 
tion. 

By many it has been regarded as a disease of the membranes, 
by which they adhere with abnormal tenacity to the maternal 
placenta. While the tufts of the chorion are very long and nu- 
merously branched, and sink into the recesses in the cotyledons 
of the mother, they have no power within themselves of holding 
fast to the maternal tissues. It has already been stated that, at 
no time during fetal life, is there any direct communication be- 
tween the maternal placenta and the placental tufts of the cho- 
rion, but they are always normally separated by two layers of 
epithelial cells, the one maternal, the other fetal. 

It has long been believed and taught that, under certain dis- 
eased conditions, adhesions take place between the tufts of the 
fetal chorion and the corresponding septa of the maternal pla- 
centa, but no such adhesions have as yet been observed by his- 
tologic examination. While we are not in a position to deny the 
possibility of such adhesions, it is certain that, if they occur at 
all, they are so rare as to constitute no important elemeni in the 
question as a whole. 



794 Veteri7iary Obstetrics 

Retention of the fetal membranes in the cow is due primarily 
to the incarceration of the tufts of the chorion within the crypts- 
of the maternal cotyledons. 

Recentl}' Pomayer,' in a very extended study, has quite well 
shown the principal causes of retained afterbirth by histologic 
research, and his findings and conclusions are in full accord with 
clinical experience. Pomayer holds that retained fetal mem- 
branes are due to inflammation and swelling of the maternal pla- 
centa, that is, placentitis or cotyledonitis. The lesions within 
the cotyledons may be of two classes, aseptic and septic. 

During pregnancy an animal may receive a blow, be gored by a' 
cow, or meet with some other external injury which may more 
or less detach some portion of the chorion from the maternal pla- 
centa. Hemorrhage may take place to a limited degree, followed 
by a more or less extensive inflammation, with new formation of 
connective tissue between the mucous membrane of the placenta 
and the epithelial tufts of the chorion. Should the hemorrhage 
between the two parts become very great, it may cause so exten- 
sive a separation as to induce the death and expulsion of the 
fetus. If the hemorrhage is not so great, and the inflammatory 
processes already mentioned take place, the fetal membranes may 
become more or less incarcerated and held over a limited area, 
but there would be no general retention of the entire fetal mem- 
branes, or rather we would say that, in the cow, the fetal mem- 
branes would become readily detached from all the cotyledons 
save one or two which had been implicated in the injury during 
pregnancy. With this group of cases, we have little to do, and 
clinically it is virtually negligible. 

The important group, from the practitioner's standpoint, con- 
sists of those cases in which infection plays the chief role and 
the retention of the afterbirth is finally maintained by the in- 
flammation of the maternal placenta. By observing Figs. 79 and 
139, it will be seen how intimate is the relation between the chorion 
and the cotyledons in the cow, and it will be readily understood 
that, when the cotyledons become inflamed and swell, the very 
complex chorionic tufts may become more or less immovably 
fixed and held. 



' Das Zuriickhalten der Nachgeburt beim Rind, by Dr. Phil. C. Pomayer, 



Retained Placenta in the Cow 795 

The advent of cotyledonitis may vary in different cases. In 
many instances, the disease of the placenta precedes the expul- 
sion of the fetus, and consequently, at the time of the expulsion 
of the calf, the pathologic conditions which must result in reten- 
tion of the fetal membranes are already present, and fully devel- 
oped. This is especially true in contagious abortion, in which 
there is frequentlj^ more or less infection of the cotyledons, prior to 
the expulsion of the uterine contents. If the abortion occurs 
early in pregnancy, before the chorionic tufts have become de- 
veloped, the fetal membranes are regularly expelled along with 
the aborted fetus. Later in pregnancy, after the chorionic tufts 
have become more developed, with corresponding complexity of 
the maternal placenta, retained afterbirth becomes very common, 
and is referable to the existence, at the time of the expulsion of 
the fetus, of a distinct inflammation of the maternal placenta, 
which incarcerates and holds the chorionic tufts of the fetal pla- 
centa. In other cases, also,- inflammation has already advanced 
into the uterus, and brought about an inflammation of the coty- 
ledons, prior to the expulsion of the fetus. In the granular vene- 
real disease of cows, where the granular inflammation extends 
into the uterus, if the death of the fetus fails to be brought 
about, but instead its premature expulsion is caused, the cotyle- 
dons readily suffer, and the expulsion of the immature fetus may 
be followed by the retention of the membranes. 

When a pregnant animal has suffered for a long period of time 
from prolapse of the vagina and of the vaginal portion of the 
uterus, the uterine cavity is very prone to become infected, since 
the chief barrier to uterine infection, the healthy vagina, has 
been replaced by a diseased and infected organ. 

Similar conditions prevail when torsion of the uterus has oc- 
curred, because compression and stretching of the tissues have 
greatly decreased their power of resisting infection and permitted 
the infection to extend into the uterine cavity and involve the 
placenta. Any cause which may operate in such a way as to 
permit the access of disease-producing organisms into the 
uterine cavity may at any time cause infection of the maternal 
placenta and bring about a degree of inflammation and swelling 
which will eventually cause a retention of the fetal membranes. 

In the other important group of cases, those in which the dis- 
eased condition occurs after the completion of birth, infection 



796 Veterinary Obstetrics 

is favored in a quite different manner. The observations of 
Pomayer upon this point are very exact and convincing. If 
birth has been difficult, if the animal is weak and debilitated, or 
if the uterus is in a debilitated state from the expulsion of the fetus, 
retention of the fetal membranes is very probable. The expul- 
sion of the fetus has exhausted, in these cases, the contractile 
powers of both the uterus and the abdominal walls. In most 
cases of parturition, there is a definite and well-marked exhaus- 
tion at the completion of the act, and a period of rest at once 
follows. Later, when the animal system and the uterus have 
recovered from the exhaustion of parturition, contractions of the 
uterine and of the abdominal walls normally occur, and serve to 
press out any remaining fetal fluids, and the afterbirth, and 
close the uterine cavity. 

If, for any reason, the exhaustion is abnormal and the con- 
tractions of the uterine walls do not recur promptly, infection 
takes place very quickly. As soon as the navel cord is ruptured, 
the fetal membranes at once cease to live, and assume the signifi- 
cance of a foreign body. The entire mass of membranes is dead 
tissue, filled with fluid and containing portions of the fetal 
fluids which have not been thrown out. Taken together, the 
membranes and the fluids constitute a highly favorable breeding 
ground for disease-producing organisms. ■ Usually the broken 
end of the navel cord hangs from the vulva, comes in con- 
tact with bedding, feces, urine and other substances reeking in 
micro -organismal life, and furnishes an excellent avenue along 
which the organisms may pass into the uterine cavity. 

Still more important, in many cases, micro-organisms of the 
most dangerous kind are introduced directly into the uterine 
cavity on the hands of laymen, or other persons who have inter- 
fered in cases of dystokia or have inserted their hands into the 
uterus immediately after the expulsion of tbe fetus. Thus there 
is abundant opportunit}' for infection of many kinds to gain 
access to the uterine cavity and, having reached that organ, find 
the conditions of heat,. moisture, nutritive material and exclusion 
of air ideal for their lapid and efiicient multiplication. If the 
exhaustion of the uterus continues for lo, 12 or more hours, the 
infection of the cotyledons has probably occurred, and within 
24-48 hours the disease processes in the cotyledons may have so 
far advanced as to firmly incarcerate and hold the chorionic tufts. 



Retained Placenta i?i the Cow 797 

The pathology of the retention of the fetal membranes is 
necessarily somewhat foreshadowed by the causes which have 
been related above. Inflammation of the cotyledons in the cow, 
or of the placenta in other animals, naturally follows the general 
course of inflammation of tissues, resulting from infection. It 
may abate in the course of a few days, and the swelling of the coty- 
ledons may decrease and result in the release of the incarcerated 
placental tufts, so that the chorion may finally come away, ac- 
companied by contraction of the uterus and prompt recovery from 
the disease. If, however, the infection is more extensive and 
virulent, the cotyledon may undergo total necrosis and slough 
away, still holding firmly incarcerated the section of chorion to 
which it is attached. We have observed this result in the cow 
repeatedly, and sometimes it has involved the necrosis and 
sloughing away of all or nearly all the cotyledons in the entire 
uterine cavity. 

The ravages of the disease do not always cease with the necro- 
sis of the cotyledons, but may extend to the walls of the uterus, 
involving the mucous, muscular and peritoneal coats more or less 
in their order, and extending beyond the peritoneal covering of 
the uterus, to involve the peritoneum in general. 

The fetal membranes undergo more or less rapid decomposi- 
tion, so that in 48 hours, as a rule, they become quite putrid and 
give off a very fetid odor. The inflammation of the uterine mu- 
cosa, endometritis, causes a more or less abundant excretion into 
the uterine cavity, which is usually very fetid and consists of a 
dirty, grayish, flocculent, semi-fluid or fluid mass, which may 
vary greatly in amount. Naturally it is mixed with shreds of 
afterbirth and placenta, and sometimes contains cotyledons which 
have sloughed away from their pedicles. In some cases, the uter- 
ine mucosa is covered over with diphtheritic membranes. 

Depending upon the degree of infection, the uterine mucosa or 
the entire uterine walls may be more or less thickened and 
changed in consistency. Sometimes the uterine walls are very 
firm and hard, as aresult of an exudative inflammation, especially 
if the disease is of somewhat long standing. At other times, the 
walls are very thick and soft, as a result of gangrene. 

When the inflammation of the uterine walls is virulent, and 
the pathologic changes serious, the uterus quickly loses all con- 
tractile power and lies as an inert organ. The pathologic secre- 



798 Veterinary Obstetrics 

tions accumulate within the organ, until sometimes it may con- 
tain four or five gallons. Any expulsion of the contents of the 
uterus must now be brought about by the contraction of the ab- 
dominal walls, including the diaphragm, and even these forces 
are too frequently in abeyance, so that the uterine contents in- 
crease more or less rapidly, and in many cases flow away spon- 
taneously, especially when the animal is lying down, simply as 
a result of passive pressure upon the abdominal walls. 

The constitutional symptoms are usually parallel to the local 
changes in the organ. The systemic disturbances will vary, 
however, according to the vitality of the patient and her power of 
resistance to bacterial products. Usually, when the inflammation 
of the uterus has extended to any considerable degree, there are 
more or less well-marked symptoms of septicaemia or pyaemia. 
These include inappetence, irregularity of the bowels, either in 
the form of diarrhea or of constipation, cardiac debility with a 
very weak or imperceptible pulse, great depression of the animal, 
cold extremities, rapid, shallow respiration, and any other of the 
long train of symptoms which may accompany septicaemia. 

The symptoms of retained placenta, in the cow, are variable, 
and include the symptoms of all the pathologic lesions which 
may result from the disease. Generally they are self-evident, 
and consist of the navel cord and portions of the chorion hanging 
from the vulva, while other portions are retained within the 
uterus. This is not always true. Sometimes the major portion 
of the chorion, and the navel cord, have dropped away, and the 
owner believes that the expulsion of the fetal membranes has been 
complete, but within the uterus there remain imprisoned more 
or less extensive portions of the afterbirth, which soon become 
infected and undergo decomposition. In other cases, the entire 
mass of fetal membranes, or essentially all, is retained within the 
uterine cavity, the os uteri has contracted, and no portions of 
the membranes protrude from the vulva, to reveal in that very 
apparent way the condition which exists. 

In addition to these usual visible signs, there are present 
symptoms of the pathologic changes which we have enumerated 
above. These may not be very marked, but the animal, soon 
after parturition, loses her normal vigor, and there are generally 
symptoms of ill health of a more or less serious character. In 
many cases, the retention of the membranes may be suspected 



Retained Placenta in the Cow 799 

from the presence of a vaginal discharge, with the general appear- 
ances of ill-health. In other cases, there occurs a more or less 
evident prolapse of the vagina. 

When retention of the placenta is neglected, the membranes 
and cotyledons may slowly slough away, the os uteri contract, 
chronic metritis and pyometra become established, marasmus and 
emaciation follow, and the disease continue month after month, 
to finally terminate in death, or in recovery with sterility. 

Under such conditions, following within a few days or a 
few weeks upon parturition, it behooves the veterinarian, when 
called to attend the animal, to make a careful search of the 
uterus. If the os uteri is open, he may profitably make this ex- 
amination direct through the vagina, but, if the os be closed, 
the examination needs be made per rectum, when the enlarged 
uterus will be discovered and the nature of the disease understood . 

The handling of retained placenta in the cow calls for care- 
ful study, and the display of great judgment. Mostly the work 
has been undertaken in a haphazard way by the layman or the 
dairyman, and these methods have been largely copied by the 
veterinary practitioner. No practice in connection with our 
professional duties could be more unfortunate. As a general 
rule, the layman or the veterinarian removes the afterbirth by 
manual force, more or less completely, at a time which is arbi- 
trarily fixed, or when it may suit the convenience of the parties 
concerned. As a result of this haphazard and unscientific 
method of handling this very serious disease, the lives of many 
valuable cows are annually sacrificed, and many more are ren- 
dered useless for dairying or other purposes. In order to handle 
retained placenta successfully, the veterinarian must first under- 
stand the physiologic expulsion of these membranes and the 
pathologic conditions which occur in the course of the disease. 
Three different courses present themselves for consideration in 
the handling of each case of retained placenta in the cow, and 
the veterinarian must use good judgment in determining which 
of these three courses Le should pursue. 

I. The manual removal of the placenta. As early as 24 
hours after parturition, the veterinarian should examine the 
retained membranes and determine whether or not they may be 
safely and completely detached by manual force, and, if practi- 
cable, should remove them. The precise time for this exaraina- 



8oo Veterinary Obstetrics 

tion cannot be definitely fixed. If the veterinarian attends a case 
of dystokia, and finds, after the removal of the fetus, that he 
can follow with the removal of the placenta, without tearing the 
cotyledons and without causing hemorrhage, this should be ac- 
complished immediately. If there are any wounds in the uterus 
or vagina, there is greater need for the removal of the membranes, 
in order to prevent wound infection and injury to the parts. If 
the fetus has been dead and emphysematous, it is quite important 
to remove the afterbirth immediately following the removal of 
the fetus, and in such cases it is generally quite practicable to 
do so. 

The operation of the manual removal of the placenta should be 
accomplished in a careful and thorough manner. During partu- 
rition, the chorion has become separated from some of the cotyle- 
dons about the cervical canal, and the farther toward the horns 
we proceed the more intimate do we usually find the attachments 
of the membranes to the cotyledons. The veterinarian should 
begin by detaching those cotyledons which are first recognizable 
posteriorly, along the top of the uterus, and then, gradually work- 
ing forward, eventually detach those from the bottom of the 
uterus and from the horns. 

The method of detachment should aim at the complete removal 
of all the chorionic tufts, without injury to the cotyledon or to 
its pedicle. The operator grasps the cotyledon with his thumb 
resting upon one side at the margin of the attachment of the 
chorion to the cotyledon and his index and middle fingers resting 
upon the opposite border of the organ. By pressing upon the 
chorion, between the thumb and fingers, the chorionic tufts are 
gradually detached and forced out of the crypts in the cotyledons, 
while no force is exerted upon the stalk of the cotyledon, and 
consequently it escapes injury. After the fetal placenta has 
begun to be detached on the side where the thumb is located, 
the detached margin may be grasped between the thumb and in- 
dex finger, while the other fingers rest upon the opposite side of 
the cotyledon, and the detachment of the chorion gradually com- 
pleted. This process is to be repeated upon one after another 
of the cotyledons, until all are finally detached. 

The operator usually has difficulty in reaching the most distant 
cotyledons located in the two horns, especially those in the gravid 
horn. This horn turns downward, and then backward, and is 



Retained Placenta in the Cow 8oi 

longer than the reach of a man's arm. The operator may bring 
these cotyledons somewhat nearer to him by having assistants 
lift upon the floor of the abdomen with a blanket or board, or in 
some cases, by gradually pulling backward on the curved horn, 
and thus drawing it toward the pelvis. If the uterine walls are 
not paretic, one may also cause a decrease in the size of the organ 
by filling the uterus with warm water and causing it to contract 
and expel the liquid. This causes a diminution in the size of 
the organ, and brings the most distant cotyledons more nearly 
within reach. 

Before beginning the operation, the veterinarian should wash 
and disinfect the vulva and tail carefully, and should irrigate the 
vagina. The operator should take precautions against infection 
of his arms and hands. For this purpose, we recommend tlie 
repeated immersion of the arms and hands in a reliable antiseptic 
fluid, and would especially recommend lysol, because of its unc- 
tuous character. Some, like Pomayer, condemn antiseptics for 
this purpose, and recommend oils or fats instead, but our expe- 
rience has been that oils and fats are almost instantly dissolved 
by the fluids present and washed away. 

We also practice and recommend the irrigation of the uterine 
cavity prior to the beginning of the removal of the afterbirth. 
We would not use, for this purpose, a powerful disinfectant, 
which would tend to cause abnormal expulsive efforts, but would 
use instead soft warm water, with a small amount of disinfectant, 
like %% carbolic acid, which, we find, tends to soothe rather 
than irritate the diseased uterus. If the uterus is too feeble to 
cause the expulsion of this liquid, and it is not accomplished by 
the abdominal walls, it should be siphoned out. 

For making the injections we prefer to use a rubber tube, 
especially the pure gum horse stomach tube, which, to our mind, 
makes an ideal apparatus for the irrigation of the uterine cavity. 
To the distal end of this, we may attach either an aseptible enema 
pump or a funnel. The funnel is cheaper, lighter to carry, and 
is highly efficient. 

If the operation of the manual removal cannot be carried to 
completion, or cannot be performed without injury to the cotyle- 
dons or causing hemorrhage, it should not, for the time being, 
be persisted in. 
51 



802 



Veterijiary Obstetrics 



The membranes should not be divided, but should be removed 
completelj' or left together attached to the uterus. One important 
element in the normal detachment of the membranes is the weight 
and volume of the chorion and umbilic cord. If the principal 
volume and weight of these is removed, the tendency for the 




Fig. 139. Placentai< Tufts from the Chorion of the 
Cow. ( Pomayer. ) 

remnant to continue to be retained is intensified. If the main 
body of the chorion is torn awa}^ and the placental tufts remain 
imbedded in the cotyledons, the incarcerated portions lose the in- 
fluence of traction, which is so necessary to their eventual re- 



Retained P/ace?ita in the Cow 803 

moval. It is the dead and putrefying placental tufts im- 
prisoned in the cotyledons, and not the other portions of 
the chorion, which constitute the element of danger in the 
disease. If we cannot remove these tissues, which con- 
stitute the fundamental danger in retained placenta, then 
we should not, under any conditions, remove those harm- 
less portions, which may later serve a highly necessary 
and useful purpose in withdrawing the imprisoned 
placental tufts. 

2. Expectant Handling. When it is impracticable to manu- 
ally remove the entire mass of the chorion, including the tnfts, 
the afterbirth should be allowed to remain in the uterine cavity 
with the detached portions hanging from the vulva. The at- 
tending veterinarian should attempt to control and alleviate the 
infection in the organ, and to retard, as far as possible, the putrid 
decomposition of the retained membranes by irrigating the uterine 
cavity with warm water, to which he may add a small amount of 
disinfectant, being careful not to use sufficient to cause any irri- 
tation of the uterus. One may use from ^ to ;4 % carbolic acid, 
or an equal amount of lysol. If the animal does not throw out 
the injected liquid, along with the accumulated discharges in 
the uterine cavity, it should be siphoned out by means of a tube. 

It is wrong to leave this fluid in the uterine cavity, where it 
can work no good. We cannot di.sinfect the diseased tissues, 
because any disinfectant sufficiently powerful to pass into the 
tissues and destroy the micro-organisms must destroy the tissues 
before the micro-organisms are reached. It is of great use, how- 
ever, to remove from the uterine cavity the accumulated disease 
discharges or bacterial products. The washing should be re- 
peated at least once a day, and should be continued each time 
until the fluid, when expelled or siphoned out, is comparatively 
clear and free from odor. When this has been siphoned out, 
there should be deposited within the uterus some antiseptic which 
will tend to obviate any increase of the infection, without in- 
ducing any marked irritation of the diseased organ. In our 
judgment, the most reliable drug for this purpose is iodoform, 
which may be introduced into the uterine cavit3'in the powdered 
form, enclosed in a gelatine capsule, which the operator may 
leave to dissolve or may open and scatter the powder about in the 
various parts of the uterus. This plan has been carried out by 



8o4 Veterinary Obstetrics 

us, and some of our colleagues, with very satisfactory results. 
Possibly other antiseptics, such as powdered boric acid, would 
prove of similar value, introduced in the same manner. 

The patient should be examined daily. If it is found that the 
inflammation in the cotyledons has abated, so that the chorion 
may be eflfectively detached, the manual removal of the membranes 
should be proceeded with. If they are still firmly held, the treat- 
ment should be repeated, and so, daj' by day, the case should be 
carefully watched, until finally it is possible to remove the chorion 
complete, including all the placental tufts. 

3. Removal of the Cotyledons. The preceding plans may fail 
and the disease proceed rapidly to the necrosis of the cotyledons. 
Sometimes this necrosis is very acute, and calls for prompt recog- 
nition and handling. We observed especially, in one case, where 
apparently infection had been carried into the uterine cavity by 
the operator, while overcoming dystokia, that placental gangrene 
was well established in about 24 hours. The cotyledons were 
enormously enlarged, very firm and tense. Thej' were about four 
times their normal volume. The fetal placentae could not be de- 
tached from the cotyledons, but it was found that the cotyledons 
themselves were very easily detached from the uterus, and this 
was not followed by hemorrhage or by any apparent pain. 

The cotyledons were, one after another, detached and with- 
drawn, with the chorion still firmly attached to them. No mate- 
rial hemorrhage followed. The uterus was immediately irrigated 
with warm water, to which about %% oi carbolic acid had been 
added. The cow, which had previously shown all the cardinal 
symptoms of septicaemia, accompanied by a very high tempera- 
ture, improved immediately after the operation, and within 24 
hours her temperature, appetite, and general condition were 
normal. She made an uneventful recovery, and in due time 
again became pregnant. 

In other cases of retained placenta in the cow, we have fre- 
quently found many or all of the cotyledons lying free within the 
uterine cavity, still attached to the chorion, Sometimes we have 
been able to distinguish these enlarged necrotic cotyledons when 
they were almost ready to drop off, and have removed them with 
good results. In one case, in a valuable cow which had been 
neglected, we found the os uteri rather firmly closed. In the 
uterine cavity lay the entire chorion, with the cotyledons still 



Retained Placeiita in the Cow 805 

firmly attached to it, but sloughed away from the uterine walls. 
The removal of the cotyledons and chorion, with irrigation of the 
uterus, was followed by uneventful recovery, without destroying 
the fertility of the cow. 

Because of these experiences with necrosis of the cotyledons, 
we hold in all those cases where the uterine walls are compara- 
tively sound and the cotyledons have undergone necrosis, that 
the veterinarian is not only warranted in removing them, but 
that their removal is clearly indicated as the proper surgical 
procedure. 

Such removal of the cotyledons in the cow is somewhat anal- 
ogous to the curetting of the placenta in woman. It produces, 
in proper cases, the same results. It removes the decaying frag- 
ments of the fetal membranes and the irrecoverably diseased 
maternal placenta. 

While the decomposing chorionic tufts are incarcerated within 
the crypts of the cotyledons, and the cotyledons are yet alive but 
diseased, the diseased surface, from which bacterial poisons may 
be absorbed, is the superficial area of the mucosa of all the pla- 
cental crypts. When the cotyledon has been removed, the re- 
ceptive surface is reduced to the area of the cross section of the 
cotyledonal stalk — probably less than loooth part of the area of 
the placental epithelium. 

The collateral handling will vary greatly, according to cir- 
cumstances. If the patient is not seriously depressed, if she is not 
straining abnormally, if her temperature and appetite are good, 
there is no call for general medication. When there are evi- 
dences of serious constitutional disturbances, such as fever and 
weakness, the patient should be supported and strengthened by 
easily-digested, nutritive foods, if she will take them, to which 
may be added stimulants and tonics. Alcohol is especially use- 
ful, and may be given in large and frequent doses. When sj'mp- 
toms of septicaemia appear, it has been our practice to administer 
large doses of quinine, and in our experience the results have 
been good. 

Some have practiced and advised the administration of 
ecbolics such as ergot, savin and rue, but this is opposed by many 
and the clinical evidence of the value of this group of drugs is 
not clear. 



8o6 Veterinary Obstetrics 

Others, and with more reason, advise and use carminatives and 
aromatics internally, such as anise seed, fenugrec, gentian, and 
camotjiile, or the gum-resins like camphor and others. They 
are probably of distinct value as adjuncts to the local handling. 

In many cases, great good may come from prompt catharsis, 
and for this purpose we prefer one of the hypodermic cathartics, 
such as eserine or arecoline. Owing to the feebleness of the 
heart, we would administer it in small and repeated doses, com- 
bined with strychnine, and continue it until the desired evacua- 
tion of the bowels has been brought about. This in itself fre- 
quently causes a great reduction of the temperature, and marked 
improvement of the general symptoms. 

The food should be easily digestible. Such highly nutritious 
food as linseed meal serves an excellent purpose, while roots are 
also valuable, because of their keeping the bowels more or less 
freely open. 

The prevention of retained afterbirth in the cow is an im- 
portant problem, which offers hope for success in numerous cases. 
It is highly important, from the standpoint of prevention, 
that, in all cases of dystokia attended by a veterinarian, the after- 
birth should be removed, if possible, immediately after the re- 
moval of the fetus, followed by irrigation of the uterus, bringing 
about its firm contraction. It is also important that the owners 
of pregnant animals should keep them in vigorous condition, 
allowing plenty of exercise, air and light, with an abundance of 
good digestible food, for some weeks at least prior to parturition. 

A very important element in the prevention of retained pla- 
centa, and for which the veterinarian is directly responsible, is 
the question of handling in cases of dystokia. In discussing the 
general handling of dystokia on page 620, we have already em- 
phasized the value of aseptic precautions in all these operations. 
It is well to repeat here the duty of the veterinarian to take every 
possible precaution against carrying infection into the uterine 
cavity while he is dealing with a case of dystokia. To this end, 
he needs to follow out carefully the rules which we have alreadj^ 
laid down regarding sterilization or disinfection of his clothing, 
his hands and arms, his instruments, and the exposed parts of 
the patient. 

As soon as fears of placental retention are entertained, the 
veterinarian can, and should, do much to obviate the disease. 



Retained Placenta iyi the Cow 807 

Copious irrigation of the uterine cavity, within a few hours after 
calving, washes away placental debris, fetal fluids and retained 
blood clots, stimulates uterine involution, and greatly favors the 
spontaneous expulsion of the membranes. 

The irrigating fluid should be at least as warm as the uterine 
cavity, but not of appreciably higher temperature, and should be 
of soft water or softened by the addition of soda bi-carbonate, to 
which may be added 0.6% of salt. 

The irrigation should be begun as early as convenient after 
calving, and may be repeated every 4 to 6 hours. The irriga- 
tion is to be carried out under antiseptic precautions, and very 
gently. When the horse stomach tube we have advised is used 
for irrigation, the properly lubricated end can be pushed forward 
gently, and with some rotary motion, through the vagina and 
into the uterine cavity, usually without inserting the hand, thus 
avoiding the manual introduction of infection. The tube is 
rigid enough to be reasonably subject to external direction, and 
pliable enough to obviate any danger of wounding the genital 
tract. 

The prognosis of retained placenta is exceedingly variable, 
but must always be cautious. Whenever the afterbirth can be 
completely removed manually within 24-48 hours after calving, 
the prognosis is highly favorable. It must, however, depend 
upon the state of the uterus itself, and upon the general vigor of 
the animal. If the uterus is highly inflamed and paretic, the out- 
look is always serious. 

In our experience, the most serious cases have usually been 
those where some party has unsuccessfully attempted to remove 
the membranes, and has merely succeeded in tearing away the 
major portion of the chorion, leaving many of the fetal placentae 
still firmly attached to the cotyledons, and naturally leaving many 
of the cotyledons themselves more or less seriously injured. 
When this has been done, and severe straining follows, accom- 
panied by a high temperature and loss of appetite, we have found 
the disease highly fatal. On the other hand, the uterine walls 
may be very intensely inflamed, firm, paretic, and yet recovery 
occur. Pomayer has emphasized the value, in this disease, of 
the degree of leucocytosis in the uterine walls. It is, he says, 
the number of leucocytes which exist in the uterine walls, or 



8o8 Veteri7iary Obstetrics 

which may be attracted to them, which brings about recovery. 
If the infection of the cotyledons and of the uterine walls is of 
such a character as to destroy the leucocytes, recovery cannot 
occur. 

2. Retained Placenta in the Mare. 

Retention of the placenta is much less frequent in the mare 
than in the cow. Clinically, retention of the placenta in the 
mare is divisible into two separate forms, total and fragmentary. 

Total retention of the fetal membranes in the mare corre- 
sponds in a measure to the disease in the cow. It is, however, 
very rare, not only as related to placental retention in other ani- 
mals, but also as compared with the fragmeutal retention in this 
animal. 

The rarity of placental retention in the mare is explained upon 
various hypotheses. Most significant, perhaps, is the compara- 
tive simplicity of the chorionic tufts, so that any swelling of the 
uterine mucosa does not tend materially to incarcerate them and 
hold the chorion. It bears another important difference when 
compared with ruminants ; the placenta is diffuse. The chorion 
is thick, rigid, not readily compressible. When involution of 
the uterus occurs, the area of attachment in the uterine mucosa 
rapidly decreases, while the opposing chorionic attachments are 
not subject to like diminution in area and are consequently de- 
tached. The placentse of sheep and goats are essentially as intri- 
ate as those of the cow, and are upon the same general plan, but 
retention of the fetal membranes in rhese is very rare as com- 
pared with the cow. According to our observations also the dis- 
ease is less common in the ewe than in the mare. Hence the 
arrangement of the placental structures does not wholly control 
the probability of retention. 

The causes of total placental retention in the mare are analo- 
gous to those already mentioned in the cow, such as placentitis 
as an accompaniment of contagious abortion, and fatigue of the 
uterine walls during difficult labor, followed by infection. 

The symptoms of total placental retention in the mare usu- 
ally consist merely of the visible protrusion from the vulva of 
the umbilic cord and portions of the chorion. There is rarely 
any straining. If neglected, and infection occurs, as it does very 
quickly, a diffuse endometritis quickly follows, the chorion usu- 



Retained Placenta m the Mare 809 

ally sloughs away, the uterine walls become paretic, voluminous 
excretions into the uterine cavity occur, and the cavity of the 
organ is soon occupied by two to five or more gallons of a dirty 
grayish, flocculent, stinking semi-fluid mass. Following closely 
upon these changes, perhaps even noted first, parturient lamini- 
tis occurs. 

The handling of total retained placenta in the mare consists 
of the manual removal, and should be undertaken at the earliest 
convenient time subsequent to parturition. In cases of dystokia, 
the veterinarian should remove the membranes as soon after de- 
liver}' has been completed as possible, allowing merely a few 
minutes for the animal to recover from her exhaustion. 

In removing the afterbirth of the mare it is to be remembered 
that ordinarily the chorion comes away everted, but when we 
desire to remove it artificially it should be done right side out. 
First the veterinarian needs locate the margins of the rupture in 
the chorion through which the fetus has been expelled. Neces- 
sarily' this margin is detached for some distance from the torn 
border. 

Secure the torn border and carefully draw it out through the 
vulva. Insert the open hand or clenched fist between the chorion 
and uterine wall, and, while exerting enough traction upon the 
ruptured margins to keep the chorion tense, gently and cau- 
tiously push the hand along between the chorion and uterine 
wall. The process should be carried out almost equally around 
the entire circumference of the uterus, and the chorion gradually 
detached until the coruna are reached and included. 

In many cases of retention in the mare, it is not actually needful 
to insert the hand into the uterus. If the protruding chorion be 
carefully grasped, folds of it picked up first here and then 
there, and gentle traction exerted upon each area by turn, if will 
soon be found that drawing upon a given part of the chorionic 
sac causes dehiscence of the placenta and distinct advance is 
made. Section after section is cautiously tested, and gradually 
the entire chorion comes away with the placental side outward. 

If there has been no infection, if the operator has not inserted 
his hand, nothing further is demanded. 

If there is infection in the uterus or if the operator has inserted 
his hand, the uterus should be well irrigated with tepid water to 
which 0.5% carbolic acid may be added. This should be repeated 
as frequently as conditions demand. 



8io Veterinary Obstetrics 

Fragmentary placental retention is in a way peculiar to the 
mare. It consists in the accidental transverse rupture of the 
chorion of the non-gravid cornu, followed by the chorionic mass 
from the gravid cornu and uterine body coming away, and leav- 
ing behind the small isolated fragment in the non-gravid horn. 

This fragment is usually 8 to 12 inches in length, and its lumen 
sufficiently large to admit of the insertion of a man's hand into 
its cavity. 

The cause of this retention is not far to .seek. The chorionic 
mass of the mare is very heavy, and she usually stands while the 
membranes are being expelled. The non-gravid cornu is last to 
expel its membranes, so that, before the chorion in the non-gravid 
cornu becomes detached, it must support the weight of the re- 
mainder of the membranous mass. At this time the greater mass 
of the chorion hangs outside the vulva, and the umbilic cord 
drags upon the ground, where it may be stepped upon and the 
attached area of chorion torn off. Possibly the cord is still intact 
and the foal, in trying to rise, may partly do so and fall, giving 
a violent pull upon the cord, which is promptly transmitted to 
the still attached strip of chorion in the non-gravid cornu, and 
causes it to give way. 

Once this fragment becomes separated, the narrow horn has 
little or no expulsive power and the mechanical assistance ordi- 
narily afforded through the weight of the other portions of the 
chorion is wanting. 

Infection of the isolated fragment quickly follows. In two to 
five days the chorionic fragment has become well decomposed,, 
the uterine wall has become inflamed, the abdomen is very 
tender upon pressure, the infection has spread throughout 
the uterus (purulent endometritis), extensive purulent col- 
lections have occurred in the uterine cavity, the uterine 
walls are thick, hard and paretic, and parturient laminitis is 
present. 

At about this time, if the veterinarian will carefully explore 
the uterine cavity he will be able to recognize by touch the re- 
tained segment of chorion, somewhat loosened and readily de- 
tached, putrid, fragile and extremely fetid. He will not always 
find the piece as it may have sloughed away and passed out. In 
one such case, as we approached the recumbent patient, she sud- 
denly sprang to her feet. As she did so, there came a gush of 
pus from the vulva, in which was the tell-tale fragment of chorion. 



Retained Placenta in Small Animals 8i i 

The handling consists fundamentally of a careful search for, 
and removal of, the retained chorionic fragment, followed by the 
proper handling of the resulting endometritis and laminitis. 
These we shall discuss later. 

This type of retention is subject to preventive measures. 
The veterinarian, when attending a mare in labor, or removing 
the fetal membranes when completely retained, should always 
carefully note whether the two horns of the chorion are complete. 
If not, the missing apex should at once be removed and the 
uterine cavity well irrigated. 

3. Retained Placenta in the Smaller Animals. 

The smaller domestic animals do not suffer so frequently from 
retained placenta as do the cow and mare. The ewe and goat 
with cotyledonal placenta suffer occasionally. The sow and car- 
nivora suffer but rarely from retention. De Bruin records teta- 
nus infection in the ewe as a result of placental retention. Gen- 
erally the disease in the ewe has about the same danger as in the 
cow. The sow withstands the disease well. 

The handling is somewhat similar to that in the cow. If the 
genital canal is large enough to admit of the insertion of the 
operator's hand, manual removal may be carried out as in the 
cow. Otherwise the uterine cavity is to be irrigated with warm 
normal salt solution, thus mechanically cleansing the organ, 
stimulating normal involution of the uterus and increasing pre- 
sumably the number of leucocytes in the uterine walls. De Bruin 
condemns the use of antiseptics in these cases. 

Should chronic metritis, with chronic vaginal discharge or 
with vaginal prolapse, follow, hysterectomy, page 669, may be 
indicated in the sow and carnivora. 



11. WOUNDS AND INJURIES TO THE GENITAL 
AND NEIGHBORING ORGANS. 

PosT-PARTUM Hemorrhage. 

Post-partum hemorrhage is comparatively rare iu domestic 
animals, and occurs chiefly in the larger species. In woman 
hemorrhage following childbirth is very common as a result of 
the highly developed and vascular placenta, but in domestic 
animals, in which there are generally more or less diffuse pla- 
centse of the disseminated or cotyledonous form, the conditions 
are such that we rarely observe spontaneous placental hemorrhage. 
In fact we have no definite records to show that serious placental 
hemorrhage proper, occurs in animals, although slight hemor- 
rhage from the placenta is quite commonly observed in the mare 
and cow, and to a lesser degree in other domestic animals. 

The hemorrhages which occur during or immediately subse- 
quent to parturition in domestic animals are generally due to 
traumatic injury which is more or less independent of the pla- 
centa, although it may naturally involve that structure. We 
have already had occasion to mention, on page 457, that in rare 
instances uterine hemorrhage occurs during gestation and may 
with extreme rarity prove serious. 

During the act of giving birth to young, serious and fatal 
hemorrhage is not exceedingly rare, especially in the mare, as a 
result of a rupture of the uterine walls involving some of the 
great vessels of the organ. Necessarily in the mare it involves 
in the lesion the placenta itself, since this is distributed over the 
entire organ. After the expulsion of the fetus, whether in the mare 
or the cow, there frequently follows immediately a considerable 
discharge of blood, which may be placental in origin, but which 
is more probably due to the rupture of uterine vessels of con- 
siderable size. The point of origin and the exact character of 
such a hemorrhage is ver)' rarely determined. 

After the fetus has been expelled, the rude removal of the fetal 
membranes by laymen or empirics frequently induces profuse 
hemorrhage, which may even end fatally. In the mare, if the 
chorion is very firmly adherent to the uterus and violence is used 
to bring about separation, the mucosa may be wounded to such a 
degree as to cause profuse hemorrhage. In some cases of re- 



IVoicnds and Injuries to the Getiital Organs 813 

tention it is impracticable to separate the envelopes at once be- 
cause of hemorrhage due to the uterine injuries. In the cow, 
when the placenta is retained and involution of the uterus has 
not 3ret occurred, and the layman or empiric attempts to de- 
tach the membrane, profuse and fatal hemorrhage is liable to 
result, which is greatly accentuated when the cotyledons are rudely 
torn away from the uterus. 

In one instance observed by us, an empiric attempted to remove 
the membranes from a cow immediately after calving, and, by 
tearing them away, brought on a hemorrhage which proved fatal 
to the patient in the course of a few hours. When we were 
called, the entire uterine cavity was filled with a great mass of 
blood ; much blood had already escaped from the vulva ; the 
cow was down, and unable to rise ; the mucous membranes were 
blanched ; the animal was pulseless, and in a dying condition. 
In the mare we have observed fatal hemorrhage as a result of 
ruptures during difficult labor. 

Hemorrhage from the uterus occurs also in cases of pro- 
lapse or inversion, and usually of two types. There may be a 
general capillary hemorrhage from the entire mucous surface, or 
rather from the placental surfaces of the uterus, and there may 
also occur hemorrhage from wounds of the uterine walls or 
placentae involving large vessels. 

Symptoms. Generally there is an escape of blood from the 
vulva. The blood may, however, be largely retained within the 
uterus, and coagulate promptly. In case of rupture of the uterine 
walls, and especiallj^ of the uterine floor, when involving large 
vessels, a profuse and even fatal hemorrhage may occur into 
the peritoneal cavity, without any appreciable amount of blood 
escaping from the vulva. In these instances of intra-uterine 
or intra-peritoneal hemorrhage, the symptoms, in general, are 
those of internal hemorrhage, such as the blanching of the 
mucous membranes, weakness Of the animal, pain, anxiety and 
sweating. Death frequently follows quickly. The diagnosis 
must be made by these symptoms, in conjunction with a manual 
exploration of the uterine cavity. 

The indications in uterine hemmorrhage will depend largely 
upon the cause and origin. When due to extensive wounds of 
the uterine walls, involving the large vessels, and the uterus is in 
position, it is well-nigh beyond the obstetrist's control, though 



8 14 Veterinary Obstetrics 

it might be possible in some cases to secure the wounded vessel if 
it could be identiiied. In the milder forms of hemorrhage, where 
the quantit}' of blood is not great, it may not be necessary or even 
advisable to interfere, especially if the uterine cavitj^ is in an 
aseptic condition. When the hemorrhage is dependent upon 
a want of involution, contraction should be encouraged by such 
means as we have at command. 

If the organ is intact, we may hasten involution b}^ the injec- 
tion into it of a tepid solution of an antiseptic or a normal salt 
solution, or we may attempt to favor involution by the ad- 
ministration of ergot or of stimulants. It may be also that the 
involution can be hastened in some cases by the introduction of 
cold water or of ice into the uterine cavity, and at the same time 
the hemorrhage somewhat checked by the cold. 

In hemorrhage from the prolapsed uterus, we can not hope to 
check that of a capillar\' character except by the reposition of 
the organ; while that from any torn vessels of importance can be 
readily controlled with the aid of forceps or by ligation or other 
means in common use. Digital compression, applied for some 
time, may bring success. 

When a quantity of blood has accumulated in the uterus and 
coagulated, it should be promptly removed and means applied to 
cause uterine involution. 

2. Rupture of the Uterus and Vagina. 

In all domestic animals, rupture of the uterus or vagina is 
liable to occur at any time during labor, and especially toward 
the close of the act, as the fetus is being forced along the genital 
passages. The organs are again subject to rupture because of 
their prolapse or eversion of the organs. 

The accident occurs in a great variety of ways. Frequently it 
occurs through the projection of some part or extremity of the 
fetus in an improper direction, so that it is forced through the 
wall of the organ because of a concentration of pressure upon a 
small area. Ruptures from this cause naturally occur most fre- 
quently in the mare and cow, where the fetus has long and rigid 
extremities; which are capable of inducing great injury when 
they become misdirected. 

In transverse presentations in the mare, when version, is at- 
tempted without embryotomy, there is always danger of an 



Rnphire of the Uterus and Vagina 815 

extremity becoming so misdirected that, during the expulsive 
efforts of the mother, it may be forced through the uterine wall 
and bring about a perforating wound of the peritoneal cavity. 

In the anterior presentation, with the two posterior limbs ex- 
tended beneath the body of the fetus and lodged just in front of 
the pubic brim upon the uterine floor, the forcing of the fetus 
into the passage brings about a great concentration of pressure 
upon the uterine floor by the feet. The croup and thighs are 
rigidly and firmly pressed against the sacrum and lumbar verte- 
brae, while the extended limbs are forced, under enormous pres- 
sure, downward and forward against the floor of the uterus. 
Such pressure is constantly liable to cause the toes of the fetus 
to force their way through the uterine floor. 

When the fetus presents anteriorly in the dorso-sacral position, 
with a foot crossed over the head, or a foot misdirected upward 
from other causes, the misplaced extremity tends constantly to 
push upward and force its way through the roof of the vagina. 
So with other misdirections of the anterior or posterior ex- 
tremities. 

In the bicornual development of the fetus, as already described 
on page 716, extensive and fatal rupture of the uterus is very 
liable to occur when traction is applied in order to bring about 
delivery. 

In torsion of the uterus, as already related on page 704, trans- 
verse rupture is a common result of the displacement, and follows 
regularly when the torsion has acquired an extreme degree. 

A further and not rare can.se of uterine rupture is the attempt 
of the veterinarian to force a fetus through a constricted passage, 
or a fetus which is too large or presents improperly through a 
normal passage. In discussing the question of atresia or indu- 
ration of the cervex uteri, we related an experience in which, in 
a heifer, we attempted to force the fetus, normal in size and posi- 
tion, through a very narrow cervical canal, with the result that 
we ruptured the cervix for its entire length. 

Another, and highly important, way by which rupture of the 
uterus may be caused during traction consists in tearing and 
rupturing the walls of the organ by forcing it against some pro- 
jecting portion of the pelvis, as already described on page 676. 
We meet occasionally in the mare and cow with projections or 
eminences upon the pelvic inlet, which assume such a form that, if 



8i6 Veterinary Obstetrics 

the uterine wall is forced against them, it is liable to become seri- 
ously injured or even punctured. In some instances there occurs, 
first, severe maiming or contusion of the organ, of such a char- 
acter that its vitality is destroyed over a small area, the devi- 
talized area becomes infected, and eventually a small slough takes 
place, which establishes a communication between the uterine 
and peritoneal cavities. 

In other cases, when forced extraction is attempted with a fetus 
in an improper position, such as a deviation of the head, the 
uterine wall may be caught by some projecting portion of the 
fetus, and dragged along in such a way that it doubles upon itself 
and thus tends to bring about its rupture. 

Of all the ruptures of the uterus, the most embarrassing and 
unfortunate are those which are brought about by improper 
manipulation or accident upon the part of the obstetrist himself 
or through the meddling of laymen or empirics. In discussing- 
the general subject of obstetric work upon page 623, we have 
already suggested that it is to the professional and legal interests 
of the veterinary obstetrist to examine very carefully each case 
of dystokia to which he is called, and determine whether or not 
the animal has been subjected to injurious meddling before his 
arrival, and discover, if possible, any important injuries which 
may have taken place, before he attempts to handle the case. 

Again, in discussing the method or plan for overcoming dys- 
tokia or accomplishing obstetric work, we have urged on page 
630 that the veterinarian should always use care and judgment 
and that he should especially husband his strength to conserve 
his efficiency. In one instance, in our own practice, we had 
labored long and ineffectively to correct a lateral deviation of the 
head, in a case of wry-neck, when we should at once have re- 
sorted to embryotomy. Finally, after becoming exhausted, we 
made an attempt to secure the head by means of a long, blunt 
hook, and in our exhausted condition failed to properly control 
the direction of the instrument, caught it in the uterine wall and 
tore a large opening, which at once demanded the destruction of 
the patient. 

Sometimes, in cases of prolapse of the uterus, the animal gets 
the prolapsed organ caught upon obstacles of various kinds and, 
dragging upon it, brings about a more or less serious rupture. 
It is not very rare for the prolapsed uterus to be torn and lace- 



Rupture of the Uterus and Vagina 817 

rated by other animals. Especially is this true of the cow when 
she suflFers from eversion of the uterus in an enclosure where 
swine can get to her, as these animals at once pounce upon the 
prolapsed organ and begin to devour it, if it is within reach. In 
one case cited by Fleming, almost the entire organ had been de- 
voured. Just as the condition was discovered the cow got up, and 
the remnant of the organ suddenly returned to its place. The 
animal recovered. 

At the normal time for parturition, or when abortion occurs, 
the uterus may become ruptured from emphysema of the fetus, 
or rupture may follow dropsy of the amnion. 

The symptoms of rupture of the uterus are perfectly obvious 
in the prolapsed organ. When the organ in its normal position 
becomes ruptured, the symptoms will vary according to the posi- 
tion and extent of the rupture, the degree of hemorrhage, and the 
character and volume of substances which may escape from the 
uterine, into the peritoneal cavity. If the rupture is very exten- 
sive, and a large amount of liquids, especially if infected, escape 
into the peritoneal cavity, there is at once a profound collapse, 
under which the animal is liable to die very suddenly. If the 
rupture is extensive, and immediately after the extraction of the 
fetus the veterinarian is so unfortunate as to inject into the 
uterine cavity a large volume of antiseptics for the purpose of 
irrigating the organ, and these escape instead into the peritoneal 
cavity, the collapse is sudden and death may ensue in the course 
of an hour or two. 

When the rupture involves the division of voluminous blood 
vessels, the chief symptoms may be due to the hemorrhage, as 
already described in the preceding chapter. If the rupture oc- 
curs in the roof of the organ, or so high along the sides that it 
does not cause the escape of large volumes of liquids into the 
peritoneal cavity, there may be no symptoms presented at first, 
and it may pass undiscovered except through the medium of 
manual exploration. L,ater, infection may gain admission into 
the peritoneal cavity, through the rupture, and bring about a 
septic peritonitis, with all the symptoms of that disease. 

When the rupture is very small and amounts to a mere perfo- 
ration, or when a small area of the organ is so contused that it 
looses its vitality to later become necrotic, and the peritoneal 
cavity becomes secondarily opened, the definite symptoms, septic 
52 



8i8 Veterinary Obstetrics 

peritonitis and its accompaniments, are slow to ' become estab- 
lished. It may be several days after parturition before the}^ be- 
come apparent, and the definite diagnosis may be made only upon 
post-mortem examination. 

In one instance occurring in our clinic, the owner of a mare 
had inhumanly drawn away a foal while the head was com- 
pletely deviated to the side, and, in doing so, had caused a com- 
plete rupture of the perineum. When the mare was presented 
at our clinic because of this injury, the afterbirth was still re- 
tained. This was removed, and the ruptured perineum was reg- 
ularly cleansed and disinfected. Although we had examined 
the uterus carefully, we had failed to find any injury of its walls, 
and concluded that we had only to deal with the retained 
placenta and the ruptured perineum, but we were in error. The 
mare perished three days after entrance into our clinic, under 
symptoms of septic peritonitis. Upon po,st-mortem examination 
there was revealed a small rupture of the uterus along the floor, 
just anterior to the pubic brim and located upon the median line. 
The opening was barely sufficient to admit the passage of a pen- 
cil ; its edges were necrotic ; and it could not be determined from 
its appearance whether the rupture had been direct or complete 
at the time of the dystokia or whether it had first consisted of a 
contusion, which had been later followed by gangrene and a 
sloughing of the uterine floor. Most probably it had at first con- 
sisted of a contusion, the result of impingement of a uterine fold 
between the fetus and a bony prominence of the maternal pelvis, 
during the inhuman forced extraction. 

In another instance occuring in our clinic, some stablemen had 
delivered a cow without any antiseptic or other reasonable pre- 
cautions, and the delivery was followed by retention of the pla- 
centa. Though we removed this carefully and, as we believed, 
judiciously, the cow exhibited the general symptoms of perito- 
nitis, to which she succumbed. A post-mortem examination re- 
vealed a small perforation of the uterine floor, just in front of the 
pubic brim, in the same position essentially as in the preceding 
case of the mare. 

Again it was impossible to determine if the perforation was 
immediate or secondary. In each case we were criticised be- 
cause of the death of the patient. 

These cases suggest the importance of care in examining the 



Rupture of the Uterus and Vagina 819 

uterus in all instances where there has possibl}- been tampering 
before the veterinarian has been called, and should clearly im- 
press the practitioner with the importance of using all due pre- 
cautions in any manipulations which he undertakes. It must be 
evident to him that, when he is attempting to adjust a retained 
foot, he should be very careful not to bring excessive pressure 
upon this point of danger at the pubic brim, because of the con- 
stant possibility of causing a small perforation of the uterine 
floor. We have suggested that, in the extension of a foot which 
has been retained, the operator should always grasp the toe 
in the palm of his hand, and cause it to glide over the pubic brim 
without coming in contact with the uterine floor. This point is 
highly important, not only because it actuallj' facilitates the ope- 
ration, but also because it affords a highly necessary security 
against serious or fatal injury to the organ. 

The handling of rupture of the uterus must be adapted to 
each individual case. When the uterus is in position, it is rarely 
possible to close a rupture by means of sutures or otherwise. It 
should always be remembered that the involution of the uterus 
brings about a great decrease in the .size of a rupture in its 
walls. 

When the organ is prolapsed and ruptured, it is comparatively 
simple to close the opening by means of sutures under proper 
aseptic precautions. The sutures .should be of silk, and of the 
intestinal type, that is, the peritoneal surfaces should be brought 
in contact with each other while the wound margins project into 
the uterine cavity. When the rupture is in the roof of the uterus 
or well up on its side, there is always a possibility of spon- 
taneous recovery, and every opportunity should be allowed for 
its occurrence. 

In all cases of uterine rupture it is clearly inadvisable to inject 
liquid antiseptics or other fluids into the uterus, and take the risk 
of their escaping into the peritoneal cavity. If it is essential to 
remove blood clots, fetal envelopes or disease excretions, this 
should be accomplished without irrigating the organ. The opera- 
tor may largely remove these with the hand, which can be used 
somewhat as a scoop, and the cleansing may be completed by 
means of a piece of gauze saturated with an antiseptic. 

Rarely it may be practicable to grasp a ruptured uterus, 
and by traction, with the patient under general anaesthesia, draw 



820 Veterinary Obstetrics 

the ruptured part out through the vulva, where the injury may 
be properly sutured. 

When the ruptured organ is prolapsed, and the rupture is so 
extensive that recovery is very doubtful, the organ should be am- 
putated, which operation is described under " Eversion of the 
Uterus." 

3. Rupture of the Bladder. 

Rupture of the bladder during parturition is a very rare acci- 
dent. Fleming cites two cases, one by Furnivall (Veterinarian, 
Vol. 33, page 377), in which a mare died very quickly after the 
expulsion of the fetus, and a post-mortem examination revealed 
nothing pathologic except rupture of the bladder. In the other, 
recorded by Overed, the mare was not seriously' unwell after foal- 
ing, but it was noted that she urinated more frequently than usual 
and the act was accompanied by pain. However, she was well . 
enough that she was bred to a stallion on the 9th da}', and it was 
only after four weeks had elapsed that Overed was called to ex- 
amine the animal. She later died under symptoms of peritonitis, 
and, upon opening the abdomen, a large quantity of fluid, said 
to be about 12 gallons, escaped, which was supposed to be urine. 
Diffuse peritonitis was present, and a rupture existed in the 
bladder, which communicated with the peritoneal cavity. It 
was assumed that the fundus of the bladder was injured during 
parturition, and that it later sloughed through. 

4. Rupture of Intestines. 

In rare instances, rupture of the intestines may occur during 
parturition, either because they are over-filled or weakened at 
the tiriie, or because an intestinal loop becomes engaged between 
the pelvic inlet and an unyielding portion of the fetus as it ad- 
vances along the birth canal. Fleming cites Schaack as having 
observed one instance of a rupture of the intestine by its 
becoming compressed between the fetus and the pelvic bones. 

The symptoms of such an injury, especially in the mare, would 
be those common to rupture of the intestine, and would consist 
chiefly of collapse, with very feeble or indistinguishable pulse, 
trembling, and cold sweats. It is well-nigh impossible to make 
a positive diagnosis of this condition during the life of the ani- 
mal, and it can merely be suspected from the general symptoms. 
It is not po.ssible to apply any effective method of treatment. 



Ruphire of the Diaphragm 821 

5. Rupture of the Diaphragm. 

, It has been claimed that rupture of the diaphragm occurs rarely 
as a complication or accident of parturition, in some cases of 
dropsy of the amnion or allantois, or from other causes which 
maj' induce extraordinary weight or volume of the gravid uterus. 
The few cases which are recorded are not very significant, and 
exhibit no definite symptoms by which the accident is to be 
diagnosed. 

The diagnosis has been made post-mortem. It is quite possi- 
ble that some of the cases diagnosed as rupture of the diaphragm 
as a parturient accident may have been post-mortem lesions, such 
as frequently occur an hour or two after death. 

7. Rupture of the Sacro-Sciatic Ligaments. 

Fleming cites one case of rupture of the sacro-sciatic ligaments 
in the mare, during the expulsion of the fetus, but the symptoms 
which he relates are very vague in so far as establishing the 
character of the alleged injury is concerned. A filly was un- 
able to rise after parturition, and an examination led the attend- 
ing veterinarian, Naylor, to conclude that the sacro-sciatic 
ligament had been ruptured. We fail to see how a rupture of 
the sacro-sciatic ligaments could prevent an animal from rising 
or standing, or why the rupture should have caused an extreme 
atrophy of the muscles of the affected hip, as was recorded in 
this case. The symptoms recorded point rather to an injury of 
the gluteal nerves, to which we shall refer later. 

8. Prolapse of the Intestine through the 

Ruptured Walls of the Uterus 
OR Vagina. 

When a perforating wound or rupture of the walls of the uterus 
or vagina occurs at any point, it is possible for a protrusion of 
the intestines to follow. This prolapse, however, does not ordi- 
narily follow when a wound is made through the walls of the 
vagina or uterus in the non-pregnant animal. The prolapse is 
probable only in those cases where there is violent straining, as 
seen in parturition or immediately following it. In spaying the 
mare or cow through the vagina, though the veterinarian habitu- 
ally makes a more or less extensive wound, large enough in the 
mare to admit the entire hand, there is virtually no danger of 



82 2 Veterinary Obstetrics 

the protrusion of the intestine. In uterine or vaginal rupture in 
difficult parturition, where the intra-abdominal pressure is enor- 
mously increased by the straining, a portion of the intestine fre- 
quently passes into the uterus or vagina, and finally beyond the 
vulva. 

We have already noted that in some cases a rupture of the 
uterus is caused by the meddling of empirics, by whom some 
rude instrument is used, and that through this rupture the in- 
testines protrude, if the fetus is prevented from escaping. In 
one instance which we observed, an effort had been made to 
catch some portion of the fetus by means of a hooked stick, 
and in so doing a large rent had been caused in the wall of the 
vagina. The fetus was retained within the uterine cavity 
because of bad position. The expulsive efforts of the mare forced 
the floating colon through the rent in the vagina, so that upon 
my arrival the intestine had protruded beyond the vulva so far 
that it dragged upon the ground. 

The indications usually are to at once destroy' the patient, 
since the prognosis must necessarily be extremely bad. The 
protrusion generally occurs before the expulsion of the fetus, and 
it then becomes almost impossible to extract the fetus without 
incidental injurj' to the intestine and infection of the peritoneal 
cavity. If it be possible to return the intestines with hope of 
saving the life of the patient, this should be done, and measures 
taken to keep the intestines out of the way until the fetus has 
passed beyond the point of injury. After the fetus has been re- 
moved, it may in some cases be possible to suture the wound in 
the uterus or vagina in order to guard against further prolapse 
and decrease the danger of infection. 

9. Prolapse of the Bladder through a Rupture 
IN THE Floor of the Vagina. 

When the floor of the vagina becomes ruptured during partu- 
rition, there is a somewhat remote pos.sibility that the urinary 
bladder may be forced out through this rupture and extend into 
the vagina or vulva. Necessarily such a prolapse involves the 
bending of the organ upon itself to an extent which tends 
to cause an obstruction to the passage of urine through the ure- 
thra, and thereby favors an accumulation of urine in the bladder. 
The accident is an exceedingly rare one, and has occurred only 
with sufficient frequency to establish the possibility. 



Prolapse of the Bladder 823 

The symptoms consist of the presence of the prolapsed organ 
in the vagina or vulva, with its fundus turned backward toward 
the vulvar opening, or protruding through it, according to the 
degree of distension. The organ is right side out, and shows the 
peritoneum upon its surface. A careful examination of the floor 
of the vagina will reveal, the presence of a rupture, through which 
the organ protrudes. In the mare or cow, a further test of the 
character of the injury may be made by inserting a finger into 
the urethra and passing it along that canal until it turns upward, 
to reappear again in the vagina inside the prolapsed organ. 

The indications in such cases are to return the bladder to its 
proper position, under aseptic precautions, and suture the wound 
in the floor of the vagina, bringing the peritoneal surfaces of the 
vagina in contact. If the bladder should be so greatly distended 
that it is exceedingly difficult or impossible to return it through 
the rupture, the urine may be drawn off by passing a small trocar 
or hypodermic needle into the distended organ and allowing the 
urine to escape. 

10. eversion of the uterus. inversion of the 
Uterus. Uterine Prolapse. 

' Eversion or prolapse of the uterus is a common and formidable 
obstetric accident, especially liable to occur in cows, chiefly in 
those which are largely confined in stables for dairying purposes. 
It is possible in any domestic animal, though not common in the 
smaller species. 

The accident consists at first of an invagination of the anterior 
extremity of a cornu into the succeeding portion, essentially' in 
the same manner as intussusception of an intestine. Should the 
invagination continue, the invaginated portion finallj' appears at 
the vulva, and, passing beyond, constitutes a prolapse or evagina- 
tion. When the eversion becomes complete, there is necessarilj- 
involved with it a prolapse of the vagina as well. In the incom- 
plete forms, and in the beginning of the displacement, there 
exists merely an intussusception or invagination of one of the 
horns to a limited degree, and it is only by the extension of this 
that the accident becomes complete. In uniparious animals, 
only the gravid cornu becomes everted, but the non-gravid cornu 
is prolapsed along with the everted gravid one, hidden from 
view and recognizable only as a diverticulum extending inwards. 



824 Veterinary Obstetrics 

In multipara but one horn is usually involved, because its prolapse 
through the body of the uterus prevents the other horn from 
becoming everted. 

Symptoms. The inversion usually begins in one of the 
cornua, whether in a uniparous or a multiparous animal. When 
the displacement has proceeded to only a very limited degree, the 
chief symptom observed is that of expulsive efforts, which 
differ very little, except in intensity, from those of parturition. 
There is more or less uneasiness on the part of the animal, with 
some symptoms of colic, as shown by kicking at the belly and 
looking toward the side. These, combined with expulsive efforts, 
should direct attention at once to the uterus. 

In the larger domestic animals, where the uterus can be readily 
examined with the hand, a careful search at this stage will reveal 
the gravid cornu occluded at some point in its length by a rather 
hard projection into its canal. Upon examining this projection 
it will be found that there is an opening in its center, and also 
that the fingers may be passed around between the tumor and the 
direct wall of the cornu. A further studj^ of the conditions 
present will show the obstetrist that he is dealing with a begin- 
ning inversion of the cornu. 

If measures are not at once taken to remedy the displacement, 
the constant tendency is for the intussusception to extend toward 
and involve the body of the uterus and the vagina, and later ap- 
pear at the vulva, to soon pass beyond and project as a large 
bleeding mass. The prolapsed uterus is characteristic in ap- 
pearance, and should not be mistaken for any other organ. It 
may still be covered by retained fetal membranes, which should 
be readily distinguished. In ruminants the cotyledons are very 
conspicuous, and serve to fully reveal the character of the 
accident. 

In the mare the mucous surface of the uterus has a dark red, 
velvety appearance, and is studded thickly over with the placental 
villi. To the inexperienced, the appearance of the chorion may 
cause confusion between this membrane and the mucous surface 
of the uterus. They are well-nigh identical in their general ap- 
pearance, and can be distinguished onlj' bj' a careful examination. 
Especially is this true when the chorion is being expelled 
right side out, instead of being everted, as usual, during 
its expulsion. 



Ever s ion of the Uterus 825 

In all cases, a careful examination reveals the exact character 
of the accident, by the fact that the protruding organ is continu- 
ous with the vulva and vagina. When the eversion is extensive 
and complete, it forms a characteristic tumor, varying in its ap- 
pearance somewhat according to species. In the mare and cow it 
constitutes an immense pear-shaped tumor, which, when the 
animal is standing, hangs down to the neighborhood of the 
tarsus. The mucous surface has become external, and capillars- 
hemorrhage occurs upon its surface. L,itter and other foreign 
substances may be adherent to its exterior. 

If the eversion has existed for a considerable period of time, 
the organ becomes dark, and occasionally covered with an exu- 
date, or, if it is of very long standing, with pus. It may be badly 
torn and abraded, or even gangrenous. 

The position of the uterus causes an intense mechanical con- 
gestion and an enormous increase in .size. 

The general symptoms are by no means uniform, and one will 
occasionally observe a cow, with her uterus quite completely 
prolapsed, grazing or ruminating almost as though nothing had 
occurred. In some instances the condition produces such de- 
bility that the animal is unable to rise ; or perhaps in more cases 
it might be said that prolapse of the uterus frequently occurs in 
animals which are so weak that this additional disturbance 
weakens them to such a degree that they can no longer rise. 
In other cases the animal is recumbent because the displacement 
constitutes one of the symptoms of parturient paresis, and not 
becau.se of the presence of the prolapsed organ. When gangrene 
of the organ occurs, the extreme debility and collapse from the 
septicaemia may bring about a paralysis which prevents the 
animal from standing. 

The symptoms may be modified and complicated by the rela- 
tions of neighboring organs, which tend also to become displaced. 
The vagina has necessarily been involved in each case of com- 
plete prolapse, and even the vulva is involved to a degree because 
of the great weight of the protruding organ dragging upon it, so 
that in many cases in the mare or cow, if the hand is inserted 
into the vulva, it can scarcely reach the boundary line of the 
vagina until it comes in contact with the recurved wall of the 
prolapsed organ. Naturally the bladder and rectum are more 



826 Veter7iary Obstetrics 

or less displaced, and tend to be drawn into the pelvic canal, to 
occupj' a position somewhat in the center of that cavity, and the 
urethra becomes doubled upon itself in such a way as to interfere 
with the escape of urine, while inside the uterus one or more 
loops of the intestine may extend down to the fundus of the pro- 
lapsed organ. 

We have already referred, on page 8 1 6, to the danger of rupture 
of the prolapsed uterus in various ways. 

The interference with the circulation in the organ, and the 
irritation of the atmospheric air, constantly accentuate the ten- 
dency to congestion and inflammation of the organ, while its 
denuded surface offers an excellent avenue for the introduction 
of infection. Thus we maj- observe uterine prolapse ending in 
gangrene, abscesses or tetanus. The usual form of infection 
which supervenes upon this exposure is that of metritis. Flem- 
ing, citing Funk, records an instance where, in the bitch, the 
prolapse of one cornu prevented the expulsion of fetuses which 
still remained in the other horn, necessitating Caesarian section 
for their removal. 

The prognosis of prolapse of the uterus is exceedingly vari- 
able, and must always be highly unfavorable except artificial 
assistance is given, since there is no possibility of spontaneous 
reduction. Fleming cites one case in a cow in which the organ 
was devoured by pigs, after which she recovered. Generally 
speaking, death is inevitable, unless the case has judicious at- 
tention. Even then the mortality is high. The rapidity with 
which death occurs will vary according to circumstances and 
complications. In ordinary cases the animal may live for several 
days, while in special instances, as in parturient paresis in the 
cow, death may ensue within a very few hours, rather because 
of the paresis than of the prolapse. 

The prognosis depends very largely upon the promptness with 
which competent assistance is given. It is always unfavorable 
in neglected cases, and very much more favorable where prompt 
attention is given. 

The prognosis is very greatly influenced by species, being 
very much more favorable in the cow than in the mare. Flem- 
ing, citing Deneubourg, states that in an extensive experience 
he had not lost a case ; and the same author cites Moens as hav- 
ing had 27 cases without a fatality. Other writers have lost 



Inversion of the Uterus 827 

as high as 25 to 30% of cases in the cow. The statistics regard- 
ing fatahties in this accident are not rehable because, like in too 
many other instances, there is a tendency for veterinarians to 
record their successful experiences and remain silent regarding 
those where the termination has proven fatal. In the mare the 
accident is highly fatal. Saint-Cyr, from statistics given, re- 
cords a mortality of 74%, and Zundel of 50%. These figures 
are probably misleading, due to the fact that the successful and 
not the fatal cases have been recorded. 

In our own experience, prolapse of the uterus in the mare has 
been very rare. One or two instances occurred where the pro- 
lapse appeared immediately upon the expulsion of the fetus, when 
the mare was in a dying condition, and where death followed 
within a few minutes. In only one instance, in the mare, did pro- 
lapse of the uterus occur in such a way as to call for definite 
treatment, and this animal survived. She was unable to stand 
after the reduction of the prolapse, and required slings. Before 
she had become strong enough to warrant our removing these, 
tetanus set in, and the slings were retained until she recovered 
from that disease. 

Repeatedly after dystokia we have recognized a beginning in- 
version of the gravid cornu in the mare. Having given it imme- 
diate attention, we have been able to promptly correct the posi- 
tion of the organ, and the animal remained well. However we 
cannot count these as cases of prolapse, but simply as begin- 
ning cases, in which a certain degree of inversion had occurred. 

In the cow our experience on the whole has been unfavorable, 
because we have encountered a number of cases of this accident 
as a complication of parturient paresis, in which it has proven 
universally fatal. In other instances the results have been more 
satisfactory, with recovery in more than 80% of cases. In the 
smaller animals, inversion of the uterus is highly unfavorable, in 
so far as replacement is concerned, but they verj' largely recover 
after amputation of the organ. 

The relation of prolapse of the uterus to the breeding of the 
animal has not been very carefully studied. As a general rule, 
if the organ is promptly returned it seems to have little or no in- 
fluence upon the fecundity of the patient so far as has been ob- 
served . 



828 Veterinary Obstetrics 

Once the accident has occurred, its recurrence is probable at 
the next parturition, and when such animals are rebred they 
should be watched the next time they give birth to young. 

Causes. Prolapse of the uterus has been attributed to a 
variety of causes. The accident necessarily demands the 
presence of a freely dilated os uteri, and consequently occurs 
very soon after parturition. It frequentl}' appears immediately 
after the expulsion of the fetus, in both the cow and the mare. 
In some instances in the mare, the organ has followed the fetus, 
and has required immediate replacement. In these instances it 
seems that the closely investing uterine walls adhere more or 
less to the fetal body, and tend to be dragged out yvith it, so that, 
as the last portion of the fetus escapes from the vulva, the uterus, 
apparently adherent to it, follows immediately. In other cases 
in our experience, the foundation for the later prolapse is 
apparently laid at the time of the act of birth, by the apex 
of the gravid cornua becoming inverted. We suspect that many 
of the cases of inversion of the uterus have their foundation in 
such accident at the time of the expulsion of the fetus, and 
that, if the uterus were carefully examined at the time, the 
beginning of what is later to constitute a prolapse would be found, 
though the prolapse itself may not be complete until after one 
or more days. Exhaustion of the contractile powers of the uter- 
us, and the expulsion of the fetus wholly through contraction 
of the abdominal walls, or with traction, tend to produce the 
prolapse. 

Aside from a derangement in the contractile power of the or- 
gan, by which a partial intussusception occurs in the gravid 
cornu, a very prominent cause is tardy involution of the uterus, 
with failure of the cervix to contract, consequently leaving the 
organ more or less open and flaccid. 

A further cause of prolapse of the uterus is the presence of an 
irritant in the body of the organ, such as infection or retained 
placenta, each of which may cause expulsive efforts, and at the 
same time may delay a proper involution of the organ. 

Closely allied to tardy involution is the question of the com- 
parative amplitude of the genital passages in the so-called roomy 
animal, and especiall}' one of a more or less phlegmatic tempera- 
ment. In this relation we find general influences at work, such 
as close confinement with overfeeding, which is so often seen in 



Inversion of the Uterus 829 

dairy stables, where the accident is far more common than in the 
field. In our experience, among cows which are kept for rais- 
ing beef cattle and constantly run at large, the accident is 
almost never seen. 

Anatomical peculiarities exert some influence upon the proba- 
bility of inversion of the uterus. We have already related, on 
page 29, that the broad ligaments of the uterus of the cow are 
attached to the abdominal walls more posteriorly than those of 
the mare, and hence the uterus is not held so far forward in the 
peritoneal cavity. When pregnancy occurs, the broad ligaments 
become greatly amplified, and when parturition occurs these bands 
are so greatly elongated that the uterus can readily become pro- 
lapsed, so far as these attachments are concerned, without their 
becoming ruptured or even veiy greatly stretched. In spaying 
the non-pregnant cow we can draw the ovary very nearly to the 
vulva. From this standpoint, the cow is more liable to prolapse 
than is the mare. On the other hand, the cervix of the uterus 
in the cow is more narrow and contracts more promptly than 
that of the mare, so that, if the contraction takes place normally 
in each, the mare would be more subject to the accident from this 
standpoint than the cow. 

We must constantly recognize, as a contributory cause of pro- 
lapse, anything which greatly debilitates the animal. Difiicult 
and prolonged labor is so frequently followed by prolapse of the 
organ that it must be regarded as one of the causes of the acci- 
dent, although it by no means follows that dystokia should 
directly cause this displacement. We repeatedly see cases where 
powerful traction has been employed without inducing any dis- 
placement of the uterus. On the other hand, we meet with 
cases of prolapse of the organ where the parturition has been 
natural and easy. 

When the fetal membranes are abnormally retained, and cause 
irritation and expulsive efforts, they are liable to cause a prolapse 
of the organ. Eversion is further facilitated by the fact that, in 
the presence of the membranes, the cervix of the uterus does not 
undergo its normal constriction. Very naturally, any injudi- 
cious traction upon retained membranes tends to cause prolapse 
of the organ. For example, when the chorion of the mare is 
separated from all parts except the apex of the gravid cornu, 
severe traction upon the membranes is liable to cause the beginning 



830 Vetermary Obstetrics 

of an inversion of the horn, and the irritation causes a continua- 
tion of the displacement until the prolapse results. 

Parturient paresis acts as a distinct and not very rare cause of 
prolapse of the uterus. Apparently this cause has been over- 
looked by many veterinary obstetrists. In these instances we 
have the ordinary S3'mptoms of parturient paresis, such as coma, 
coupled with a sub-normal temperature, and a general state of 
unconsciousness in the recumbent animal. In the cases which 
we have observed, three in all, we could not determine from their 
history whether the ordinary symptoms of paresis occurred first 
or the prolapse was the initial symptom. Naturally, when 
uterine prolapse complicates parturient paresis the animal is 
found in recumbency, usually lying prone upon her side. This 
induces tympany, by which the paresis is complicated and the 
replacement of the prolapsed organ is prevented. 

Handling. In all cases of dystokia, the obstetrist should ex- 
amine the uterus after the extraction of the fetus, in order to 
determine if the organ has assumed its proper position and rela- 
tions, and especially to determine if any inversion of the organ 
has begun. If such beginning inversion is present, as has re- 
peatedly been observed by the writer, the obstetrist should reduce 
the intussusception at once, by applying pressure upon the ad- 
vancing portion of the organ, either with the clenched fist or with 
the ventral surface of the fingers of the open hand, taking care 
at all times not to wound or otherwise injure the organ. After 
the replacement of the organ, unless there are reasons to the con- 
trary, such as a rupture of the uterus, the obstetrist should inject 
into the uterine cavit}' a large volume of normal salt solution or 
a very weak disinfecting solution, by which means the uterus is 
cleansed from any irritants which may be present. The expul- 
sion of the liquids also causes energetic contractions of the mu.s- 
cular walls of the organ, which lead to a prompt and normal in- 
volution, after which the danger from prolapse is usually, if not 
always, eliminated. The same rules should be applied when the 
veterinarian is called to attend an animal because of retention 
of the fetal envelopes, and great care should be taken not to leave 
the organ partly everted after the removal of the membranes. 

In these cases, the position of the patient is not highly essen- 
tial ; but it is very desirable that she should be in the standing 
position, with the hind parts higher than the fore parts. 



Inversion of the Uterus 831 

The handling of complete prolapse or inversion of the uterus 
offers two different plans — replacement and amputation. 

The replacement of the organ, and its retention in position, is 
always the most conservative and desirable, and should be applied 
in the vast majority of cases, including all those in which it is pos- 
sible to replace and retain it, and in which the state of the uterus 
is such that the veterinarian ma)' reasonably hope that it may re- 
cover from an}' injury or disease existing at the time of its pro- 
lapse or acquired as a result of the accident. 

For the replacement of the organ it is important that the 
animal should be placed in the most favorable position pos-. 
sible. In the larger domestic animals, where the prolapse has 
not existed for a very great period of time, the standing position 
of the animal is frequently preferred. Whether the animal is 
standing or lying, it is always to the advantage of the obstetrist 
that its bodj' should be more or less sharply inclined from be- 
hind downwards and forwards, so as to throw the weight of the 
abdominal viscera against the diaphragm and away from the pel- 
vis, in such a way as to favor a spontaneous reduction of the pro- 
lapsed organ. 

When the prolapse is complete, the position of the bod}' of the 
patient becomes of the very greatest importance. Though many 
veterinarians prefer to have the animal standing, those who have 
had extensive experience in very severe and difficult cases are 
very much inclined to prefer that the animal be placed in the 
recumbent position, but never in sternal recumbency. If the 
animal is to be handled in the recumbent position, it is desirable 
that it be placed upon its side. Some hold that it is even better 
to place the animal upon her back. 

The attitude of the patient should be borne in mind, in every 
case of uterine prolapse, because it modifies the difficulties to 
be overcome, to a degree which almost surpasses belief. We 
might well illustrate this fact by an occurrence in our practice, 
where we had worked long and hard to return the prolapsed 
organ in a cow. We had worked with the patient in the stand- 
ing position, and several times had progressed far enough that 
almost the entire organ had been returned through the vulva. 
Then violent expulsive efforts would come on, and the cow would 
throw herself to the ground and undo all our work. When this 
had occurred several times, and we had worked more than an 



832 Veterinary Obstetrics 

hour, we had once more ahiiost completely returned the organ, 
when the cow again threw herself violently to the ground. This 
time, bj' accident, she fell into an excavation, and lay with her 
head down hill upon as steep a bank as would permit her to re- 
tain her position without sliding downward. When we grasped 
the uterus and again attempted to return it, it fairly fell back 
into place after one or two minutes of work, and the operation, at 
which we had worked in vain for an hour or two, was completed. 
The smaller animals, when suffering from prolapse of the uterus, 
are regularly to be more or less completely suspended by the 
hind legs. Where extreme difficulty is encountered in the mare 
or cow, she too may be partially suspended with ropes and 
pulleys from a beam. 

Having secured the animal in a proper position for the return 
of the organ, or having made the necessary arrangements for 
placing the patient in the proper po.sition, the obstetrist should 
proceed to put the organ in proper condition for its return into 
the normal position. 

If the placenta remains attached, this should be removed if at 
all practicable. In this everted state, the operation of the re- 
moval of the placenta is undertaken under the very best possible 
conditions, so that it is nearly, if not always, perfectly practi- 
cable and easy to remove it. It is needless to say that this should 
be done with very great caution, since any abrasions or lacera- 
tions of the uterus in this prolapsed state tends to produce very 
profuse hemorrhage. 

In almost all cases of prolapse of the uterus, the organ has be- 
come more or less befouled with dirt of various kinds, and espe- 
cially with manure and bedding, bearing abundant and serious 
infection, which it is the province of the veterinarian to overcome 
as far as possible. 

In order to properly cleanse the uterus, the organ must first be 
protected from further contamination by being placed upon a 
clean sheet, tray, or other suitable apparatus. Having pro- 
vided ample protection, the operator should next proceed to 
cleanse the organ, chiefly by irrigating it with a tepid saline 
solution, so as to remove most of the dirt by mechanical wash- 
ing, without irritating the organ. We may use in this solution 
a very small quantity of carbolic acid, not to exceed 0.5%. 
The washing with this solution should be very abundant, and 



Inversion of the Uterus 833 

should be accompanied by gentle massage, which will tend to 
overcome the congestion of the organ, thereby decreasing its 
volume. 

It should be constantly borne in mind by the obstetrist that 
the position of the organ, as related to the body of the patient, 
affects its size, and that, if the organ can be held somewhat above 
the level of the vulva, or at least as high as that organ, the blood 
tends to pass back into the body, thus relieving to an appreciable 
degree the engorgement of the organ, and rendering its replace- 
ment more practicable. 

If the uterus has been torn or abraded, the wounds should be 
given proper attention. If any perforations have occurred in the 
organ, thej' should be closed by means of sutures, in such a 
manner that the two peritoneal surfaces of the organ are brought 
in contact. Should any blood ves.sels be wounded, they should 
be ligated or twisted, or the hemorrhage should be otherwise 
controlled before it is attempted to return the organ to its position. 

In some ca.ses it may become necessary or desirable, before at- 
tempting replacement, to reduce the volume of the organ by 
removing a portion of the blood from it. Two plans for decreas- 
ing the volume of blood in the organ, and thereby lessening 
its size, have been proposed. 

The most direct and radical of these is scarification of the 
mucous surface of the organ. While some writers upon veterinary 
obstetrics recommend this, they do not seem to speak from the 
standpoint of experience, but rather theoretically. There can be 
no question but that these scarifications will reduce the volume 
of the congested organ, but the safety of the operation does not 
seem so clear. Saint-Cyr relates that early in his experience he 
applied scarification in a case of uterine prolapse in a mare, and 
she died from bleeding. This would seem to be a very natural 
consequence of such an operation. It would be well-nigh im- 
possible to perform very extensive scarification without injuring 
vessels of large size, and when this is done in an organ which has 
become weakened by displacement the control of the hemorrhage 
would become difficult, if not impossible. Aside from the ques- 
tion of hemorrhage, however, scarification opens up an extensive 
avenue for the entrance of infection, and the conservative obstetrist 
would avoid making these wounds. The extraction of the blood 
53 



834 Veterinary Obstetrics 

may not be advisable either, because if a verj' large amount escapes, 
even though it does not result fatally, it tends to seriouslj^ 
weaken the animal. The scarification of the prolapsed organ is 
inadvisable. 

A second method of reducing the volume of the organ is by 
causing the blood to return into the vessels of the body. This may 
be accomplished b}' a variety of means. We have already sug- 
gested that the elevation of the organ above the level of the vulva, 
accompanied "hy massage during the cleansing of the organ, tends 
to distinctly reduce its volume. Others suggest that they get 
most excellent effects from immersing the organ in cold water, 
and still others advise the use of ice. While cold may re- 
duce the volume of the organ more than the application of a 
tepid solution, it also renders it somewhat more hard and firm, 
while the tepid solution makes it soft and pliable. 

Others recommend the application of pressure by means of a 
bandage, beginning at the fundus of the organ and continuing 
toward the vulva. The plan suggested below for reducing the 
prolapse also efficiently reduces the congestion and volume. 

The reduction or replacement of the uterus is next to be 
undertaken. We have alreadj' suggested that, when the inver- 
sion is incomplete, and consists merely of an intussesception of 
the apex of the gravid cornu into the succeeding portion, the 
operation is very simple and consists merely in placing the 
clinched fist or open hand against the advancing or central por- 
tion of the displaced mass, and pushing toward the apex of the 
horn, causing it to become unfolded and to resume its normal 
position. 

When the inversion is complete, and prolapse has occurred, the 
operation becomes far more complicated and difficult. If possi- 
ble, there should always be an abundance of help at hand to give 
any necessary aid to the operator. Fleming suggests that at least 
four assistants are necessary, but in our experience we have usu- 
ally succeeded with two or three persons, though admittedly in 
severe cases it is very much better if more persons are at hand 
in case of emergency. If the animal can stand, and will do so, 
and it is practicable to return the organ with the patient in this 
position, it is not essential to have very manj' assistants, but 
even then it is usually convenient to have as many as Fleming 
suggests. Fleming would place one attendant at the animal's 



diversion of the Uterus 835 

head to hold it firmly, and in case of the cow to pinch the uasal 
septum in order tocontroljthe movements of the animal and dimin- 
ish the straining. One man would stand upon each side of the 
animal and, with a sheet or other cloth, hold and elevate the or- 
gan while it is being returned. The fourth man would hold the 
tail away, and at the same time pinch the back of the cow so as 
to prevent her straining. 

Great assistance can be rendered by two to four assistants, in 
exerting pressure upon the prolapsed uterus. A piece of sterile 
muslin or other suitable tunic is pa.ssed beneath the tumor, and one 
or two assistants grasp each end as near to the organ as will per- 
mit the operator to work. They then lift the organ at least 
as high as the vulva, and press it firmly against the vulvar open- 
ing, thus tending at the same time to push the prolapse back in- 
to the vulva and to reduce the congestion and size by forcing the 
blood back into the body vessels. 

Different operators suggest different methods for returning the 
organ. The plan which we have uniformly followed is that of 
exerting pressure upon the extremity of the prolap.sed organ, or 
as some would say, against its fundus. The pressure is thus 
made against that part of the organ which first began to evert, 
so that in replacing it the operator simply reverses the process 
by which the prolapse took place. In this operation the obstet- 
rist seeks that point in the gravid cornu where it has ceased to 
evert, a point which is recognized at the fundus or extremity of 
the mass, in the center of which there is an excavation or passage 
representing the apex of the gravid cornu, which has not become 
everted, but has prolapsed within the everted portion. 

Placing the clinched fist or open hand against this portion, the 
operator gradually and carefully pushes his hand forward, toward 
and into the vulva, as far as he can readily reach. Holding 
the advanced hand in this position, with the other he grasps 
the portion of the organ immediately surrounding the inserted 
arm and holds the uterus, while he withdraws the arm which has 
been advanced, and prevents the replaced portion from follow- 
ing his arm out. He now carries the other arm up to and 
through the vulva, pressing with it a succeeding portion of 
the prolapsed mass. He continues in this way to pass first one 
hand and then the other into the mass of the organ, and thence 
through the vulva, carrying with it the distal or ovarian end 



836 Veterinary Obstetrics 

of the cornn, until finally the entire horn and body have 
been pushed in, and have thus become replaced in the order 
of the original displacement. 

It is essential in this operation that great care be taken not to 
lacerate or abrade the organ with the finger nails, push a pro- 
jecting finger through the walls of the organ, or otherwise injure 
it. Throughout the operation the prolapsed organ should be 
kept soft and pliable by frequent irrigation with warm water or 
saline solution. 

Some have suggested that, instead of returning the apex of the 
gravid or everted horn first, the obstetrist should begin at that 
part of the organ which is nearest the vulva, and by this means 
press the uterus back through the vulvar opening. By this 
method the assistants hold the organ in the same position as the 
preceding, and the operator, acting upon the proximal portion of 
the prolapsed mass, presses his hands on either side of the tumor, 
between it and the lips of the vulva, and thus acts first upon 
the vagina, then upon the cervix and bod}"- of the uterus, and 
finally upon the everted cornu, until the replacement becomes 
complete. 

A third method is that of Coquelet, although it apparently 
does not merit the designation of being distinct from the two 
preceding. It consists essentially of applying a pressure bandage 
of a peculiar form until the organ is considerably reduced in size, 
when one of the two preceding methods is applied for replacing 
the mass. C takes a clean piece of cloth about one yard in 
length and 28 to 30 inches in width, and passes this beneath the 
prolapsed organ up close to the vulva. Its lower border is carried 
up over the distal end of the organ, and the ends are then carried 
up over the sides of the organ, until all are folded together on 
top of the uterus, completely enveloping it. While tepid water 
is kept constantly applied to the bandage, it is gradually tightened 
by pressing upon the mass underneath and pulling the corners of 
the bandage tighter and tighter until the desired amount of re- 
duction has been brought about. The prolapsed organ is then 
replaced by the method described above, or otherwise. Other 
methods for reducing the size of the organ, due to some peculiar 
way of applying a bandage, have been described. 

After the uterus has been returned through the vulva, it is 
essential that the operation should immediately be continued 



Inversio7i of the Uterus 837 

until the replacement is fully completed, since otherwise expul- 
sive efforts recur and the organ is almost certain to again become 
everted and prolapsed. When the uterus returns into the vagina, 
the operator's hand should follow it and should trace out each 
part of the cavity. Especially should he clearly distinguish the 
two cornua of the organ and make a careful search of the gravid 
horn to see that the invagination of that part has been com- 
pletely overcome. As a rule it will be found that some invagi- 
nation still exists, and this must be overcome by placing the 
clinched fist or the open hand against the invaginating mass and 
pushing upon it until the intussusception has been completely 
overcome. 

When the complete replacement has been accomplished, it is 
well to keep the hand in the cavity of the organ for a few min- 
utes, until straining and uneasiness cease, and the organ has un- 
dergone some contraction and begins to recover its tone. 
Sometimes severe straining continues, with the probability 
of a recurrence of the prolapse. The most efficient means for 
overcoming these expulsive efforts is the' introduction into the 
uterine cavity of a large volume of a warm ^ % solution of 
carbolic acid, which not only completes the replacement but 
also soothes the organ, washes away any blood clots or- 
extraneous matter, and favors a normal involution of the organ. 
As soon as the uterine cavity is well filled, the fluid ex- 
cites expulsive efforts, by which the solution is thrown out, and 
the contractions aroused in the uterine walls cause each part to 
become properly replaced. 

If the straining is very persistent, after the organ has been re- 
placed as well as possible, and the measures above suggested 
have been carried out, it may be necessary to resort to the u.se of 
narcotics or anaesthetics. Among the various remedies to over- 
come the straining, we should not forget those which may act 
locally. The tepid saline solution or the very weak solution of 
carbolic acid acts as a local soothing agent, and tends to decrease 
the irritation and overcome the straining. Iodoform also acts 
well as a local anaesthetic, and at the same time tends to guard 
against infection of the uterus, and consequently becomes of very 
great importance in retaining the organ in position. The pow- 
dered iodoform should be introduced into the uterine cavity in a 
gelatin capsule, the capsule opened and the powder scattered 
thoroughly. 



838 Veterinary Obstetrics 

Among the remedies which have a powerful influence in con- 
trolling the straining, chloral hydrate occupies an important 
place. It may be administered in a variety of ways ; in draught, 
in enema, or intra- peritoneally. Some obstetrists have advised the 
use of ether as a general anaesthetic, while others have advised 
the use of opium as a narcotic. Morphine and opium are not 
reliable agents, however, in ruminants and solipeds, and may 
excite rather than soothe. Others advise large doses of alcohol 
to the point of inducing narcosis, and this we would believe use- 
ful, even though given only as a stimulant, thus arousing the 
contractile powers of the organ. 

In the smaller animals, where the uterus is so small that the 
hand cannot be introduced, the reposition of the prolapsed organ 
is rendered difiicult and somewhat dangerous, and very frequently 
fails. To a certain degree, the finger may be used to replace the 
organ in small animals, but cannot follow it to assure complete 
replacement. In order to bring this about, it may be necessary 
to use a sound, which needs be of large size and well rounded at 
the end in order to guard against puncture of the organ. For 
this purpose a large instrument, like a horse catheter, may be 
used to push the organ into its position ; or, as Fleming suggests, 
one might use a candle, properly rounded at one end, for pushing 
the organ back into its place. If the small animal is suspended 
by its hind legs, and warm water poured into the vagina through 
a funnel, the weight of the water, with the position of the patient, 
tends to complete the replacement of the organ. 

In most cases when the prolapsed uterus has been promptly 
reduced and properly replaced, the animal becomes calm and 
ceases to strain, and a recurrence of the prolapse is not probable. 
This especially holds true in all cases where the animal can stand. 
Many obstetrists deem it essential, nevertheless, that some 
mechanical appliance should be used to prevent a recurrence of 
the eversion. However advisable this may be, it should not tend 
in any way to decrease the attention of the obstetrist to the 
measures which we have already suggested for bringing about a 
thorough replacement of the organ in every detail, its proper 
cleansing and soothing by irrigation, and the stimulation of the 
uterus to normal involution. When these are done, and thor- 
oughly done, it is only in a minority of cases that any mechanical 
appliances are essential for the retention of the organ. Admit- 



Inversion of the Uterus 839 

tedly, however, it is very unfortunate to leave an animal without 
adequate protection, and permit the recurrence of the prolapse 
after the obstetrist has left the premises. A variety of appli- 
ances for the retention of the uterus in position have been de- 
vised and applied, and are recommended or condemned by this 
or that veterinary obstetrist, largely according to his personal 
experience or prejudice. 

I. Pessaries have long been used for the purpose of retaining 
in position a uterus which has once been prolapsed or threatens 
to become so. Thej' consist essentially of an elongated and rigid 
shaft, which may be passed through the vulva and vagina into 
the uterus, and retained there by some form of external bandage 
or other mechanism, thus preventing the uterus from becoming 
everted. The uterine end needs be large and smooth in order to 
avoid possible injury to the uterus. They are constructed 
of a great variety of materials, and upon different models. 

The pad pessary is made of a stick of wood 20 or 25 inches in 
length, with a pad of as large a size as can readily be introduced 
through the vulva, fixed to the uterine end. This is firmly se- 
cured to the wooden stem, so that it cannot become dislodged, 
wliile through the other end of the shaft a cord is passed by which 
it can be fa.stened to a bandage, so that the instrument cannot be 
forced out of the organ. 

Others construct a pessary of metal, with a small ring upon 
the uterine end. This is introduced and retained in the same 
way as the pad pessary. A rude pessary is sometimes made by 
attaching a pig's bladder, filled with water, to a round stick, thus 
producing an instrument similar to the pad pessary. Others 
have suggested a rubber bag, attached to a tube to act as the 
stem of the pessary, and inflated by air forced through the tube 
into it and retained by means of a stop-cock. Still others take 
a large wine or beer bottle, fasten a stick in its mouth, intro- 
duce the large end of the bottle into the uterus and retain it 
there with a bandage. 

The value of the pessary in veterinary obstetrics is very question- 
able. It almost inevitably causes discomfort to the patient, and 
tends to induce expulsive efforts. If for any reason the pessary 
becomes disconnected, such as the pad slipping off the end of the 
shaft, the naked stem is liable to be forced through the uterine 
wall and cause serious injury. The most formidable objection to 



840 Veterinary Obstetrics 

the pessary is from the standpoint of inducing uterine infection. 
It exerts a concentrated pressure upon a small area of the organ, 
which weakens the tissues and renders them more susceptible 
to infection, while the stalk of the instrument constitutes a high- 
way from the exterior to the cavity of the organ, along which 
bacteria may freely pass. It is 110 longer much used in any 
country, so far as we can determine, and has never acquired an 
extensive foothold in American practice. 

From the standpoint of efficiency in preventing the recurrence 
of the prolapse, the pessary naturally occupies a prominent place, 
but it seems that the dangers which surround its use tend to 
completely outweigh this one advantage. 

Sutures in a variety of forms have been recommended by 
veterinary obstetrists, and are generally preferred to the pessary. 

The sutures may consist of silk, linen, hemp or other vegetable 
fiber, or of metal. The metallic sutures may be in the form of 
wire, or special metal bands may be used. The sutures are usually 
passed directly through the lips of the vulva, but they may be in- 
serted through the skin near the point of the hip, thus avoiding 
the wounding of the vulvar mucosa itself. They must neces- 
sarily be strong and deeply inserted, in order to afford that amount 
of security which the obstetrist desires. The number of sutures 
to be inserted need not be great. Usually a single suture will 
suffice, if placed sufficiently deep in the vulva, and in no case 
need there be more than two deep sutures. 

Veterinary obstetrists are by no means agreed as to the com- 
parative merits of the sutures placed directly through the vulvar 
lips and of those passing over the vulva and through the skin of 
the hips. The former are known as labial sutures, and the latter 
as hip sutures. Some practitioners claim that the labial suture 
is painful ; that the tissues, being infiltrated and swollen, may 
readily yield to expulsive efforts, tear out, and the prolapse recur; 
and that consequently the hip suture is preferable. The latter 
is applied by lifting up a piece of skin near the tuberosity of the 
ischium, passing the suture through this fold, carrying it across 
the vulva to the opposite side, and passing it through another 
skin fold at a corresponding point. Four to six of these sutures 
are advised, in sufficiently close proximity to prevent any portion 
of the uterus from passing out between them. 



Inversion of the Uterus 841 

The efficiency of sutures in preventing a recurrence of prolapse 
of the uterus is high, but not perfect. In our experience, if the 
straining of the animal is very violent, the sutures are ineffective 
and are promptly torn out by the great force applied by the 
animal. When there is little or no straining, they remain in 
position, and are effective; at least the prolapse does not recur. 
Perhaps this is partly because the sutures do not readily permit 
it, but largely because the animal does not strain. This especially 
applies to the sutures through the lips of the vulva, which we 
have seen torn out very promptly, especially in the mare, under 
violent straining. The labial sutures have the further disad- 







Fig. 139b. Rope Truss of Rainard. (de Bruin.) 

vantage that they produce wounds in the birth canal at a time 
when it is highly susceptible to infection, which may readily 
extend deeper and constitute a menace to the uterus itself. 

It is claimed that the hip sutures have a much higher efficiency 
in preventing the prolapse of the organ, and they certainly are 
highly superior from the standpoint of danger of causing infection 
to the uterus. The sutures necessarily cause pain, and suture 
infection inevitably ensues. It must consequently be confessed 
that sutures, like the pessary, have objections, although not the 
same in each case. 

The bandage or truss constitutes a third method for retaining 
the uterus. These appliances consist essentiallj' of some apparatus 



842 Veterinary Obstetrics 

which can be held firmly against the vulva of the patient, in a 
way to compress the opening and to offer thereby a more or less 
effective obstacle against the protrusion of the uterus or vagina. 
They are made in a great variety of patterns, and of various 
materials. Usually they are constructed of cord. For this 
purpose two pieces of cord about y^ inch in diameter and 12 to 
15 feet in length are used. Each is double in the center, and 
the two are united by a loop in their middle, in a way to leave 
an oval space somewhat in the form of a ring, which will sur- 
round and include the vulvar opening, but not completely close 
it. The two free ends of one of these cords are then passed 
downward between the hind legs, on either side of the udder, 
and thence forward to be attached to a collar placed about the 
neck. The free ends of the other cord are carried upward, one 
on either side of the tail, and then forward along the back, and 
secured to the collar at the top of the neck. The cords are then 
drawn sufficiently tight to exert compression upon the vulva. 

Such a truss will remain in position better if another cord 
be passed around the loins, firmly attached to each of the 
longitudinal cords at the point of crossing, and then tied tightly 
around the body. 

Such a cord not only retains the others in position, but when 
drawn tight about the loins tends to stop straining. A second 
cord, passed around the chest in a similar manner, further aids 
in keeping the truss in position. 

Other forms of the rope truss are suggested in great variety 
by different obstetrists. Some construct a truss from a band of 
leather, in which they make openings corresponding approxi- 
mately to the anus and vulva. The appliance is retained in 
position in a similar manner to. the rope truss. Other obstetrists 
prefer a metallic loop, through which compression is to be exerted 
upon the vulva. This apparatus is maintained in position by 
cords somewhat similar to the rope truss. 

With most veterinary obstetrists the truss holds first place as 
a means for retaining the uterus, after it has once been pro- 
lapsed. Its efficiency is somewhat questionable in so far as its 
direct influence is concerned. If the cord about the loins is 
kept quite tight, it may prevent the animal from straining, and 
con.sequently tend to obviate the prolapse of the organ. In 
our experience, if an animal strains severely the truss is wanting 



Inversion of the Uterus 843 

in efficiency, and the prolapsed orgati may push it aside and 
escape. According to our observations, trusses generally become 
relaxed and loosened when the patient arches her back in order 
to strain. Should we desire to prevent this relaxation, it is 
advisable in our judgment to carry the two inferior cords upward 
and forward over the flanks, and cross them over the loins of the 
animal, from whence they are to be carried downward and 
forward along the sides of the chest to pass between the fore-legs, 
and attached in such a manner that, if the animal arches her 
back in order to make an expulsive effort, the tension upon these 
cords is increased rather than decreased. 

In any event, however, the most important point is to have the 
truss very carefully adjusted, and then to watch it very closely. 
The truss cannot prevent the inversion of the organ and its pass- 
age into the vagina and vulva, but can only tend to prevent its 
prolapse through the vulvar opening. This is equally true of 
sutures. While this truss is recommended by one and that 
truss by another, the best one always is that one which is best 
applied. The actual value of the truss is not so great as many 
suppose, but after all it has an important influence from a senti- 
mental standpoint, and has none or few of the objections which 
can be raised against sutures and pessaries. Since the owner of 
an animal which has suffered from prolapse of the uterus is con- 
stantly afraid of its recurrence, it is good practice to apply the 
truss in the majority of cases simply to allay his fears, if it 
accomplishes nothing else. Should the truss become displaced 
somewhat, and the prolapse recur, the owner still considers that 
the veterinarian has at least attempted the retention of the 
organ. 

We prefer to show the owner ' how to apply the truss, 
should it become necessary, then have him watch the patient 
and so care for her that the truss will not be needed. We 
have in mind here the patient which is able to stand. If 
the patient is recumbent, the case is graver, and retention appar- 
atus usually imperative. She should be kept with her hind parts 
elevated and abdominal pressure reduced to a minimum. 

The handling of prolapse of the uterus, after the organ has been 
replaced and the precautions against a recurrence taken as sug- 
gested, demands little except to care for the general well-being 
of the animal. It is well to bear in mind that any increase of 



844 Veterinary Obstetrics 

the intra-abdominal pressure tends constantly to force the organ 
backward. This may be largely avoided by unloading the 
alimentary canal with one of the prompt-acting hypodermic 
cathartics like eserine and arecoline. The abdomen should be 
kept somewhat empty, by allowing a concentrated and laxative 
diet and avoiding bulky foods. 

If the weather is suitable, the animal will be more quiet, and 
will not show the same tendency to strain, if given its freedom 
in the pasture, where it can constantly move about in search of 
food. In inany cases when the animal seems to be very much 
irritated and shows a great tendency to straining, if it is led 
about gently for a time and its attention attracted, the irritation 
may soon abate. This movement may further tend to bring 
about a more thorough adjustment of the organ, while it stimu- 
lates normal circulation and involution of the uterus. 

It is needless to say that any food which may tend to cause 
tympany should be carefully avoided, or that constipation should 
not be permitted to occur. If an animal becomes tympanic, 
that alotie may suffice to bring about the prolapse of the organ, 
simply as a result of the increased intra-abdominal pressure. 

When there is reason to fear metritis following prolapse, its 
avoidance should be attempted by frequent antiseptic irrigations 
and the liberal application of powered iodoform in the uterine 
cavity. When metritis follows replacement and retention of the 
prolapsed organ, it should be handled according to the directions 
for handling that malady. 

The truss or sutures may be retained in position for one to 
three days, according to conditions, or, if straining continues, 
possibly for even a longer period of time. 

Amputation of the Uterus. When it becomes impractica- 
ble or impossible to return the prolapsed uterus or, after reduc- 
tion, to retain it in position, the question of its amputation arises 
with a view of saving the life of the patient, minus its power of 
breeding. The reasons for resorting to amputation of the uterus 
are chiefly three. 

I. The impossibility of bringing about a reposition of the or- 
gan. In practically all cases of eversion and prolapse of the 
uterus in large animals, it is possible to return the organ into its 
former position and retain it in place. It is claimed, however, 
that cases do occur in which reposition cannot be attained, and 



Atnputatio^i of the Uterus 845 

this is especially true in the smallerdomestic animals with very 
long uterine horns. 

2. In some cases of prolapse of the uterus, when the organ has 
remained extruded for a considerable period of time and has be- 
come more or less necrotic and seriously infected, its return into 
its usual position is followed by serious and even fatal conse- 
quences to the patient. If the uterus has been prolapsed for a 
few hours onl)^, it is not gangrenous as a rule, because the ever- 
sion of the organ does not wholly cut off the circulation in it, but 
only interferes somewhat by doubling the vessels in their course, 
so that the blood supply may be maintained for a long time, and 
in some cases almost indefinitely. As soon as the organ hangs 
down from the vulva in a complete state of prolapse, the inter- 
ruption to the circulation is important, since in addition to the 
doubling of the vessels there is also the impediment of gravity, 
which causes the organ to become greatly engorged with'blood 
and interferes in an important manner with its circulation. If 
the organ has been seriously injured by rough handling during 
dystokia, has been prolapsed for a number of hours and has been 
bruised or crushed against the floor or wall, or has for a long time 
been greatly soiled by highly infectious manure, gangrene is 
frequently inevitable. It is inadvisable to return such a uterus 
into position. The condition may cause a recurrence of the pro- 
lapse, in spite of any precautions to the contrary; or, if the organ 
is retained in its position, it may undergo gangrene, and cause 
the death of the animal. 

3. Wounds of the uterus of large extent usually call for ampu- 
tation, especially when complicated with extensive infection of the 
peritoneal surface. When only a small wound, or even 
a large one which is moderately clean, occurs, amputation is 
not necessary. It is by no means essential that the entire uterus 
should be amputated because a small portion or even half of it has 
been more or less damaged. It is presumably just as safe to am- 
putate }( or }4 a.s to amputate all of the organ, and it may at 
times be of fundamental importance that we should save a portion 
of it, if by so doing we may retain the power of breeding. Con- 
sequently, when a wound is present and we can close it accurately 
by means of sutures, we have performed an operation which is 
quite as safe as the ablation of the organ. The principal ob- 
jection to this is the fact that some infection will probably 



846 Veteritiary Obstetrics 

occur at the seat of the sutures, which may readily involve the 
general surface of the uterus. 

The prognosis of amputation of the uterus varies in 
different animals, and under different conditions. In the mare it 
is usually unsuccessful. In the cow it is a fairly successful 
operation, if undertaken indue season and carried out with proper 
care. In the smaller domestic animals it is usually quite success- 
ful, especially in the sow and carnivora. 

Technic. Before proceeding with amputation, the entire 
prolapsed organ is to be carefully cleansed and disinfected, and 
placed upon a sheet of sterile gauze or other material, where it 
may be well protected during the operation; As far as possible, 
the blood accumulated in the organ should be forced back into 
the circulatory S5'Stem by compression with the bandage of 
Coquelet as, described on page 836, or by other means. 

Great care should also be taken that other viscera are not in- 
cluded in the operation. The bladder may extend out into the 
prolapsed organ, and be caught or damaged in the operation. 
Very frequently a loop of intestine projects out into the peritoneal 
sac of the prolapsed organ, and numerous instances have oc- 
curred where veterinarians have carelessly ligated the organ and 
included the intestine, causing the death of the patient. In order 
to safelj' determine whether an5' viscera extend into the cavity 
of the prolapsed organ, the veterinarian should incise the uterine 
wall under aseptic precautions, and insert a finger or his hand 
into its peritoneal cavity. 

Amputation is to be carried out by the ligation or suturing 
of the entire organ. Some operators advise that it be 
ligated in parts, while others strongly insist that the organ 
should be ligated in toto. The latter is the usual custom, 
and probably the best. The material for the ligature may vary 
according to availability in a given case. One of the best and 
most satisfactory materials is silk tape, which is soft and very 
strong, so that it will admit of being drawn very tight. Others 
use a heavy cord of almost any character, and some veterinary 
obstetrists advise the use of a moderately thick and strong pure- 
gum tubing. 

In the larger domestic animals, the ligature should usually be 
placed about the cervix of the uterus, near to the external os, 
while in the smaller multiparious animals, in which generally 



Amputation of the Uterus 847 

but one horn is involved, it may be placed as close as possible 
to the point of bifurcation. The ligature must be applied very 
tightl)', and for this purpose powerful traction is required. The 
ligated portion necessarily becomes sharply plicated, and unless 
the ligature is drawn very tightly there will be an open avenue 
for infection to pass through the amputated stump into the 
peritoneal cavity. Unless very tightly ligated also, the partial 
disappearance of the engorgement loosens the ligature and per- 
mits the stump of the organ to slip away. 

The principle of the application of the ligature should be to 
apply it so tight that the nutrition of the portion of the stump 
beyond the ligature shall be completely cut off, so as to cause 
immediate necrosis and prompt sloughing away. 

The elastic ligature is highly' efficient, because it continues to 
contract as the tissues of the organ give way, and so tends to 
continue tight instead of becoming loosened by the yielding of 
the tissues. In applying this ligature, a piece of stout cord should 
be placed lengthwise upon the uterus, and the ligature applied 
tightly around the uterus and over the cord. The cord is then 
tied over the ligature to hold it. The ligature may be passed 
two. or more times around the organ, according to its strength in 
comparison to the size of the uterus. 

When the ligature has been securely applied, the uterus may 
be cut off at a safe distance beyond it — in the cow usually about 
3 to 4 inches. Care should be taken to leave a sufficiently large 
stump to insure the ligature against slipping when the vagina 
returns into its position. On the other hand, it is inadvis- 
able to leave an unnecessary amount of tissue, which must inevi- 
tably undergo decomposition and consequently prove a danger 
from the standpoint of infection. 

The ligature should come away ordinarily after 5 to 10 days, 
along with the necrotic stump of the uterus. Pending this time, 
the vagina should be irrigated daily with antiseptics. 

In the amputation of the organ, the veterinarian should aim, in 
all cases where practicable, to include the ovaries in order to ob- 
literate estrum along with the power of breeding. 

Closing the amputation wound by means of sutures is more 
surgical, and safer than the ligature. After thorough cleansing 
of the prolapsed organ, it should be grasped and extended by an 
assistant. A piece of heavy braided silk, about one yard long. 



848 Veterinary Obstetrics 

should be armed at each end with a heavy straight needle. The 
suturing should begin at the top, that is, opposite the superior 
vulvar commissure, and the two needles inserted at approxi- 
mately opposite points, about J^ in. from the superior border of 
the organ, each needle emerging at the point where the other 
entered. By drawing firmly upon the ends of the ligature, the 
included portion of the uterus is strangulated. The needles are 
then turned back, and reinserted at a point about ^ in. farther 
down, and the process repeated until the inferior wall or floor of 
the prolapsed organ is reached and included, when the ends of 
the suture are firmly tied together. In this manner the circula- 
tion in the organ to be amputated is completely cut off, and 
hemorrhage rendered impossible. 

The uterus may now be excised at a point 2 or 3 in. bej'ond 
the suture line, but the incision should not be at once completed. 
The incision may be begun at either end of the suture and ex- 
tended for a short distance, followed by the application of a 
second ordinary continuous suture, closing the margins of the 
new-made wounds. When the suture has reached the point to 
which the excision has been carried, the cut may be extended, 
the attachments of the organ serving merely as a means for hold- 
ing the stump while it is being sutured. The excision could be 
completed at once, and the stump held with forceps. The same 
precautions are to be taken in this operation as in ligation, to not 
wound or include the urinary bladder, intestine, or other viscera. 

When the operation is completed, and all blood clots have been 
removed, the stump may be permitted to return into the vagina. 
Whether amputated by ligature or suture, the vagina should be 
kept as nearly aseptic or antiseptic as possible during the heal- 
ing of the wound. It should be irrigated daily and dressed with 
powdered iodoform. 

II. EVERSION OF THE VAGINA. VAGINAL PrOI^APSE. 

Prolapse or eversion of the vagina may occur in any domestic 
animal after parturition. We have already dealt with pro- 
lapse of the vagina, as related to sterilit}', on page 199, and 
as occurring during pregnancy, on page 449. The character of 
prolapse of the vagina after birth, in a large proportion of cases, 
is essentially different from that seen before or during pregnancy. 
Prolapse of the vagina consists of the displacement of some por- 



Eversion of the Vaghia 849 

tion or the entire circumference of the vaginal wall, backward 
into or through the vulva. According to some authors, the pro- 
lapse consists chiefly or wholly of a displacement of the upper or 
lateral walls of the vagina, but this does not always hold true. 
In many cases the entire circumference of the vagina is pro- 
lapsed in a way closely analogous to the eversion of the uterus. 
Occasionally the vaginal prolapse includes also the prolapse of 
the vaginal portion of the uterus, exposing to view the os uteri 
externum. 

In other cases we have observed in the mare, cow and bitch the 
displacement of the floor of the vagina upward and backward 
until it protrudes through and beyond the vulva and carries 
along with it the urinary bladder, which becomes turned upon 
its transverse axis so that its fundus is directed upward and 
backward instead of downward and forward, to constitute vesico- 
vaginocele. 

Prolapse of the vagina occurs chiefly in ruminants, and largely 
because of anatomical peculiarities. The uterus of the cow 
is more readily pushed backward than that of any other animal, 
because its broad ligaments are attached more posteriorly, which 
permit a ready posterior displacement of the vagina. 

Prolapse of the vagina in ruminants is further favored by the 
fact that the organ is not so closely attached by means of the 
pelvic connective tissue, and especially by the fact that the 
prolongations of the peritoneum constituting the vesico-vaginal 
and recto-vaginal excavations extend more posteriorly in these 
animals than in others, so that a greater part of the vagina is 
covered with peritoneum, and it is consequently more free to 
move in any direction. In addition to these causes, the other 
essential conditions which tend to determine the prolapse of the 
organ exist more frequently in ruminants than in other animals. 

Etiology. Various causes have been assigned to account for 
prolapse of the vagina. One of the very common and fundamental 
causes is a relaxation of the parts, which must be attributed 
partly to the manner in which the animal is kept, very largely 
to the debilitating influences of long-continued and close con- 
finement, with high feeding. The disease is far more common 
in closely-housed dairy cows and in closely-housed ewes than in 
any other domestic animals. 
54 



850 Veterinary Obstetrics 

In addition to these predisposing causes, there may occur in- 
filtration of the walls of the vagina and surrounding connective 
tissue, at the time of birth, which causes the vagina to become 
more readily displaced. The tendency is further heightened by 
increased intra-abdominal pressure, and especially by increased 
intra-pelvic pressure. Animals which are highly fed, especially 
upon bulky food, must inevitably suffer to some degree from the 
consequences of exalted intra-abdominal pressure, and if we add 
to this a floor sloping backward, upon which the animal is con- 
stantly kept, the pressure becomes most effective upon the pelvic 
organs, tending constantly to press them backward toward the 
vulva, and finally to cause their prolapse. 

A very fruitful cause of prolapse of the vagina following par- 
turition consists of some form of chronic irritation, either in the 
vagina itself or in the uterine cavity. 

The most important and common cause of post-parturient 
prolapse of the vagina is a chronic metritis, caused b5' retained 
placenta. Such irritation will cause expulsive efforts, which 
may produce prolapse of the vagina or uterus, or both. 

Symptoms. Sometimes the prolapse appears as a reddish, 
somewhat spherical tumor, between the lips of the vulva, which 
may be visible only when the animal is lying down or when, for 
any reason, she is making expulsive efforts. In other instances 
the prolapse is much greater, and the everted organ appears be- 
yond the lips of the vulva. In the larger animals, the prolapsed 
mass may be as great as 8 or 10 inches in diameter. The exter- 
nal covering consists of mucous membrane, which may be more 
or less disguised by the adherence of dirt or of blood clots. Its 
surface may be blackened as a result of long exposure, or ulcera- 
tion, suppuration or gangrene may be present. 

As the case progresses, the tendency is for the prolapse to be- 
come more and more constant, so that finally the displacement of 
the organ is continuous. The tumefaction and enlargement of 
the prolapsed organ may become so great that its replacement is 
difficult. The inflammation and swelling render the prolapsed 
organ more friable and easily torn, and contact with the tail, 
floor or walls tends to cause abrasions and lacerations. 

The patient may eat well and her general condition remain 
good, or there may be difficulty in defecation and urination, 
with more or less persistent straining. If the prolapse is de- 



Eversion of the Vagi7ia 851 

pendent upon disease of the uterine cavity, the symptoms of 
general disease will depend upon the uterine affection rather than 
upon the prolapse of the vagina. In vesico-vaginocele, the 
irritation is very great, and the difficulty in urinating tends to 
further complicate the course of the disease, leading as a general 
rule to more or less continuous and violent expulsive efforts. 

A manual exploration shoitld be made by the veterinarian to 
determine the condition of the vagina, uterus and neighboring 
organs. 

Referring to differential diagnosis, de Bruin suggests the 
possibility of confusion between prolapse of the vagina, 
vaginal tumors, retention cysts of Bartholini's glands, and in- 
version of the bladder. A careful examination, however, will 
reveal the characters of each in such a way as to bring about a 
differentiation. Tumors of the vagina are necessarily attached 
to some portion of the wall. 

Bartholini's glands lie upon the lateral portions of the floor of 
the vestibule, and, when they become distended with retained 
contents, appear as fluctuating tumors. The prolapsed bladder 
may readily be recognized by its point of attachment, the drib- 
bling of urine from its surface at the point of opening of the 
ureters, and the absence of the urethral opening. 

The prognosis of the disease is largely dependent upon the 
cause. As a general rule it is not dangerous for the life of the 
animal, but when caused by chronic inflammation of the uterus, 
complicated by retained afterbirth, it should be regarded as 
serious. The condition has the further danger of consequent 
sterility. 

In some cases the patient may suffer from prolapse of the 
vagina for days and even weeks, with great swelling and ulcera- 
tion or necrosis of the mucous membrane, though with little 
danger for the life of the animal. One of the most unfavorable 
features of the disease is its tendency to recur. 

Handling. The first aim is the replacement of the organ, 
which should always be preceded by thorough cleansing and 
disinfection. In bringing about the cleansing of the prolapsed 
organ, care should be taken to decrease rather than increase the 
irritation present, in order that when it is returned the method of 
handling shall not cause pain, and thereby expulsive efforts. 
De Bruin advises the use of a 2 to 3% creolin solution or a 2% 
carbolic acid or alum solution, placing special emphasis upon the 



852 Veterinary Obstetrics 

latter because of its cheapness and great astringency. In our 
experience so strong a solution of creolin or carbolic acid as 
suggested by this author tends to excite straining, and thereby 
to defeat the object in view. 

The replacement of the organ is to be brought about in a way 
somewhat analogous to the reduction of prolapse of the uterus. 
The position of the animal should be the same. Great advantage 
may be gained by having the posterior parts more or less ele- 
vated. The smaller animals may be suspended by the posterior 
limbs. After having properly secured the animal and cleansed 
the organ, the protruded mass may be replaced by pressure with 
the open hands. 

The finger nails should be well trimmed in order to avoid 
abrading the organ, and the hands carefully placed in a manner 
to insure the parts against injur3\ After the return of the 
organ into place, the hand should be introduced into the 
cavity, and the walls straightened out and replaced carefully in 
detail. 

De Bruin recommends, in cases of long-standing prolapse of 
the vagina, after cleansing the organ, that a 2% alum solution 
should be applied to it for 10 or 15 minutes, after which a piece 
of cloth about i^ by 2 feet should be applied to the prolapsed 
organ and wound about it as a bandage. This is to be kept 
saturated with the alum solution, while firm and careful pressure 
is applied to the outside of the mass with both hands, until 
finally the prolapsed organ is replaced. During reposition the 
animal often strains violently, and renders the operation far 
more difficult. It may be necessary or advisable to take 
measures to overcome the expulsive efforts. An assistant can 
do much b}' attracting the animal's attention or bj' pinch- 
ing the back so as to prevent the expulsive efforts. In the mare 
the straining may be overcome to some extent by the applica- 
tion of the twitch. After the replacement of the organ it is some- 
times of importance to move the animal gently for a time in 
order to attract its attention and to overcome the tendency to 
straining. 

Where the prolapse is referable to irritation in the uterine 
cavitj', our efforts must be directed to overcoming it. The uterus 
should be thoroughly examined, and no intra-uterine infection 
or disease overlooked. After the reposition of the vagina, the 



Eversion of the Vagina 853 

cervical canal should be dilated, and the uterus irrigated with 
antiseptics. 

Hess recommends in these cases in the cow that we search for 
and press out any persistent yellow bodies from the ovaries, and 
then apply massage per rectum to the uterus . By this method 
he reports excellent results. 

In other instances the prolapse is directly referable to some 
irritation in the walls of the vagina, and, before one may reasona- 
bly hope to overcome the straining and recurrence of the prolapse 
the irritation must be removed. On page 267 we have related 
a case of vaginal prolapse due to vaginal adhesions which could 
not be mechanically controlled but was cured by chloral narccsis. 

All the various means that have been advised for preventii:g 
recurrence of uterine prolapse have alike been suggested for that 
of the vagina. The pessary is ineffectual, constantly irritates 
the organ, and tends to increase rather than decrease the straining. 

Many veterinarians recommend vulvar sutures as already de- 
scribed for prolapse of the uterus. 

It is inadvisable to apply sutures until after the cause of the 
prolapse has been removed, .since such a closure of the vulva can 
only result in harm in those instances where ovarian, intra- 
uterine or intra-vaginal disease is the cause. 

The application of the bandage, such as advised for prolapse of 
the uterus, has a very low efficiency in prolapse of the vagina, 
because the organ can readily be pushed out beneath the bandage 
whenever severe straining occurs. 

Whatever value any retention apparatus may possess, it is 
more important to overcome the cause of the prolapse than it is 
to force the organ back in its position and hold it there by 
mechanical means. If infection is the cause, and it usually is, 
then disinfection must constitute the basis of handling, and 
should be applied with that thoroughness which will secure 
efficiency. The alum solution so strongly recommended by de 
Bruin and others is commendable, because it has high value as 
an antiseptic, is very astringent, and induces but little irritation. 

Iodoform is a valuable remedy in such cases, because it 
possesses high efficiency as a disinfectant, along with a distinct 
local anaesthetic effect. Where the straining is very violent, 
because of great irritation in the vagina, it may be temporarily 



854 Veteriytary Obstetrics 

controlled by the aid of cocaine, eucaine or other local anaes- 
thetics. 

Where the irritation is acute and exceedingly difficult of con- 
trol, we may secure excellent results by complete chloral narcosis, 
extending over several hours. During this period of respite 
from severe straining, the organ may resume its normal condition. 

12. Prolapse of the Rectum. 

Prolapse of the rectum occurs rarely as a result of expulsive 
efforts during or immediately after the act of parturition. In 
the horse the anus becomes somewhat everted normally with 
each defecation, but returns at once to its position when the act 
has been completed. This peculiarity is regarded as a predis- 
posing cause of prolapse. 

In dystokia in the mare, the rectum tends to become everted 
on account of the violent expulsive efforts. In some cases, where 
difficulty in parturition has occurred and the animal is not con- 
stantly attended, the eversion or prolapse of the rectum may 
become very great, and seriously imperil the animal's existence. 

In one case occurring in our practice, a valuable mare, suffer- 
ing from dystokia, was found with the rectum prolapsed to 
the extent of 3 feet, involving about 6 feet of the organ. With 
some difficulty it was replaced in position, and the extraction of 
the foal accomplished without material delay or visible injury to 
the rectum or genital organs, but the patient perished a few 
hours later. Extreme prolapse of the rectum is sometimes 
observed in the sow during parturition. 

During labor the obstetrist should take note of any threatened 
eversion of the rectum, especially in the mare, and should take 
all necessary precautions against its occurrence. This may 
be best accomplished by having an assistant press upon the anus 
with a towel or other cloth saturated with disinfectant. When 
the organ has already become prolapsed, it should be replaced as 
promptly as possible, and retained in position. It should be care- 
fully cleansed, but does not call for very thorough disinfection, 
since it must again become infected as soon as feces pass 
back into the portion which has been prolapsed. It should, how- 
ever, be quite well cleansed, and preferably bathed in a normal 
salt or soda solution, and then returned into its place, followed 



Prolapse or Evorsio7i of the Bladder 855 

by the hand to make sure that all parts of the walls are straight- 
ened out. 

The prognosis of prolapse of the rectum in the mare during 
parturition is highly unfavorable. In other animals the prog- 
nosis is more favorable. 

13. Prolapse or Eversion of the Bladder. 

Eversion of the bladder may occur in any animal, but has been 
noted chiefly in the mare, though it has also been recorded in 
the cow and sow. The very wide urethral opening of the bladder 
of the mare tends to make the eversion of the organ in that ani- 
mal more probable, because more room is afforded through 
which the organ may pass. 

The eversion of the bladder may occur at any time immedi- 
ately prior to, during, or following labor. When prolapse occurs 
prior to the expulsion of the fetus, the integrity of the organ may 
be endangered during the passage of the fetus through the vulva. 
The accident does not constitute any great impediment to the 
expulsion of the fetus, but greatly imperils the integrity of the 
organ and the life of the patient if the fetus passes over the pro- 
lapsed organ. When eversion occurs after the passage of the 
fetus, the danger to the patient is less. 

The causes of eversion of the bladder are chiefly the exalted 
intra-abdominal pressure due to expulsive efforts, the relaxed 
and weakened state of the circular muscles of the urethra, and 
in the mare, the very large urethral opening. 

The symptoms of eversion of the bladder are of such a char- 
acter as to render diagnosis easy and clear in the majority of 
cases. A tumor appears, which is somewhat pear-shaped and 
has its attachment on the median line of the floor of the vulva, 
at the point where the urethra normally exists. In eversion the 
urethral opening has disappeared, and its place has been taken 
by the everted organ. The tumor varies in size, according to 
its degree of congestion, which is largely dependent upon the 
duration of the eversion. If the eversion is recent, or if it has 
not protruded beyond the vulva to any great extent, or has not 
been seriously abraded or injured, it presents a fresh inucous 
surface, and upon either side near the neck of the tumor maj' be 
observed the two yretral openings, from which urine escapes 
drop bj' drop, or sometimes in small jets during an expulsive 



856 Veterinary Obstetrics 

effort. If not much swollen, the bladder may remain almost or 
completely hidden, especially when the animal is standing, to 
become exposed when the patient is lying down or straining. 

It is to be differentiated chiefly from hernia of the bladder 
through a rent in the vaginal floor, and from hematoma or tu- 
mors in the vagina or vulva. In rupture of the vaginal 
floor with kertiia of the bladder, the peritoneal surface of the 
bladder remains external, and the ureters, still emptying inside 
the organ, may cause it to become distended with urine. The 
rupture in the vaginal floor is recognizable. The urethra is 
present in its normal position on the vulvar floor, and through it 
the finger or a catheter may be passed into the herniated organ. 
T\i& inucous surf ace of the f Ji^rfe^ bladder, is external, and the 
ureters. open upon the external surface. The viscus does not 
become dilated with urine, and the meatus urinarius is absent. 

In the handling of eversion of the bladder, the organ should first, 
be thoroughly cleansed by wa.shing with a non-irritant fluid, 
such as a normal saline solution. The organ should be examined 
and proper attention given to any injuries. If any perforations 
of the walls of the organ exist, these should be carefully closed 
by means of sutures, so applied that the peritoneal surfaces of 
the lips of the wounds are brought into contact. If a portion 
of the wall of the organ has been severely lacerated or contused 
or has become so badly infected or otherwise damaged that its 
recovery cannot well be expected, the damaged portion should 
be removed and the edges of the wound brought together, thus 
amputating as much of the organ as may be necessary. In such 
an operation it is essential to preserve the outlet of each ureter. 

After due preparation the organ is to be returned into its 
normal position, through the urethral opening. The operation 
is usually not difficult, especially if the organ has not been long 
everted. Grasping the organ in the hollow of one or both hands, 
the operator should press firmly and evenly over the entire mass 
until it gradually returns into its position. The operation can- 
not generally be carried out hastily. Firm and evenly applied 
pressure with the hands gradually forces the blood out of the 
organ, and reduces its volume, until finally, when the engorge- 
ment has largely disappeared, the organ is usually returnable 
through the urethal opening. ■ . 



Rupture of the Perineum 857 

After replacement, any irritation present may be ameliorated 
to some extent by irrigating the cavity with a warm saline solu- 
tion. If this does not suffice, local anaesthetics may be applied, 
such as cocaine with adrenalin chloride. General anaesthetics 
or narcotics, like chloral and morphine, may also be used in order 
to overcome the expulsive efforts, by which the replacement or 
retention of the organ is made difficult. 

The prognosis in prolapse of the bladder is usually favorable, 
if it is handled early and properly. 

14. Rupture of the Perineum. 

Ruptures of the perineal tissues may consist of a rupture of the 
vulvo-vaginal roof and ano-rectal floor in front of the sphinc- 
ter muscles of these two openings, to constitute recto- vaginal or 
ano-vulvar fistula. The lesion may extend backward from this 
opening and involve a complete division of all the tissues com- 
prised between the floor of the anus and the superior commissure 
of the vulva, so that the two openings are converted into one 
cavity, into which the rectum, the vagina and the bladder empty 
in a common cloaca. In other cases it may consist of a more or 
less extensive rupture at the superior commissure or other part 
of the vulva, without involving the anus. 

The symptoms of a rupture extending from the vulva or va- 
gina into the anus or rectum, without involving the sphincter 
muscles, are not well marked externally at first, but may be fol- 
lowed soon by swelling. At the time of the accident the obstet- 
rist or attendant may observe that some portion of the fetus has 
passed from the vulva or vagina upward into the anus or rectum. 
Later feces occasionally drop from the vulva. The relative 
amounts of feces which may escape from the vulva and anus re- 
spectively will depend upon the size of the opening between the 
two passages. There is frequently an involuntary passage of 
flatus, especially when the animal is driven at a trot. 

When the rupture of the perineum is complete, and involves 
the floor of the anus and roof of the vulva, the symptoms are well 
defined and very evident. At first there is more or less 
hemorrhage from the lacerated tissues. The tissues are greatly 
lacerated and befouled with feces, which drop into the wound, 
and thence into the vulva. There is intense infection, followed 
by extensive swelling and suppuration, accompanied by necrosis 



858 Veterinary Obstetrics 

of the lacerated tissues. After a time the lacerated wounds heal, 
with cicatricial deformity. There is no reunion of the divided 
parts, but each portion separately granulates and heals, leaving 
the perineum divided. The feces constantly fall into the vulva, 
from which they drop in an involuntary manner, after causing a 
chronic irritation and thickening of the mucous membrane. If 
the animal is moved at a rapid pace, there is an involuntary pas- 
sage of air in and out of the cloaca, which causes a repulsive 
sound, and as the air is involuntarily forced out it usually carries 
with it particles of fecal matter. 

The causes of rupture of the perineum may be divided into three 
important groups. 

1 . The misdirection of a fetal extremity, by which it becomes 
deviated upward and is forced through the roof of the vagina 
into the rectum, to eventually appear in most cases through the 
anal opening. The other fetal extremities pass through the vulva, 
and thus, as the fetus is forced along by the expulsive efforts, 
the complete rupture of all tissues between the vulva and anus 
posterior to the perforation inevitably follows. When the owner 
or obstetrist is present, and notes the threatened injury in time, 
the diverging foot or head may be pushed back into the vagiua 
from the rectum, and the delivery brought about in the usual 
way, leaving a more or less extensive tear in the recto- vaginal 
partition. Cases are recorded in which the entire fetus has 
passed intothe rectum and been expelled through the anus, thus 
leaving a very wide and extensive rent between the rectum and 
vagina. The mare is far more liable to this accident because of 
her spacious rectum, often filled with large, hard fecal masses, 
and the tendency for the long and rigid feet of the foal or its 
long and pointed nose to become displaced upward toward the 
rectum, to be forced through the recto-vaginal wall. The mare 
is further rendered liable to this injury because of the stormy 
character of her labor pains and the rapidity of the passage of 
the fetus through the birth canal. The rupture of the perineum 
in this manner is therefore essentially an accident of the mare, 
and is rarely, if ever, observed in other domestic animals. 

2. Rupture of the perineum may be caused in &ny animal by 
overstretching of the parts as the result of forcing through the 
birth canal a fetus of too large dimensions, and especially a fetus 
with one or more extremities displaced, forming a projection and 



Rupture of the Perineum 859 

abrupt increase of diameter, which may cause an increased 
tension to bear upon some portion, especially the superior com- 
missure of the vulva. We have seen complete rupture of the 
perineum in the mare, where the foal had been torn away by 
powerful traction exerted upon the two anterior limbs, whik the 
head and neck of the foal were completely deviated to the side. 

The prognosis of rupture of the perineum depends chiefly upon 
the character and degree of the lesion. When the rupture results 
in a recto-vaginal fistula, the prognosis is favorable for the life 
of the animal, and moderately favorable as to her usefulness, but 
as a general rule the animal makes an objectionable noise when 
being trotted, owing to the involuntary escape of flatus from the 
rectum through the vulva. It is possible for such animals to breed, 
providing the fistula is of such a character that the penis of the 
stallion will not become engaged in the opening during coition. 

The probability of bringing about a recovery in such cases, 
that is a complete recovery by obliteration of the fistula, is re- 
mote. We have made repeated efforts to bring about a closure 
of the fistula in two cases in the mare, and in each instance not 
only failed absolutely in our object, but left the fistula rather 
larger than smaller. A few cases of complete recovery from this 
injury appear to be recorded, but the failures are apparently left 
unpublished. 

When the rupture involves the complete destruction of the 
sphincters of the anus and vulva, and includes the floor of the 
rectum and roof of the vagina for some inches forward, the 
prognosis is again highly favorable in respect to the life of 
the animal. As in the preceding condition, there have ap- 
peared from time to time records of complete recovery follow- 
ing sutures, but here again there has been ominous silence in 
reference to the failures. How great the proportion of failures 
we do not know, but it must certainly be very, very high, 
probably more than 90% . Personally we have neither obtained a 
recover}' nor had the privilege of observing one in the hands of 
other veterinarians. 

In almost all cases the wounds granulate and finally cicatrize, 
but the lips of the wound do not unite, and the anal and vulvar 
cavities remain one, with the feces dropping into the vulva. An 
animal with complete perineal rupture which has failed to unite, 
is usually sterile. The conditions are such that successful 



86o Vetermary Obstetrics 

copulation cannot readily occur, because the penis of the stallion 
becomes deflected upward into the rectum. As work animals 
they are wholly worthless for purposes of pleasure, because of 
the repulsive sound of the involuntary passages of air in and out 
of the cloaca and the fragments of feces accompanying the ex- 
pelled air, which scatter in every direction. Unless complete 
recovery can be obtained, the value of the animal is virtually 
ruined except for the temporary purpose of nursing the foal 
should it be born alive. After this service has been rendered 
the mare usually passes into the hands of low dealers. Unless 
complete recovery can be attained, it is usually better for 
sentimental and humane reasons to destroy the animal. 

3. The thirdgroupof lesions, which consists chiefly of the tear- 
ing of the lips of the vulva at or near the superior commissure or 
elsewhere, without involving extensively the sphincter of the 
anus, the prognosis is highly favorable. Under proper surgical 
attention, the animal should be completely restored to usefulness 
in the vast majority of cases. 

The handling of these very serious accidents calls for judg- 
ment and patience upon the part of the veterinarian. In the two 
first groups, in spite of the very unfavorable prognosis, attempts 
should be made to bring about complete recovery, always giving 
to the owner an unfavorable prognosis, and thus placing the 
operator in a proper position before the handling is undertaken. 
There is nothing to lose, and if success follows the effort, the 
gain is the value of the recovered animal. 

Views vary as to the most opportune time at which an opera- 
tion should be undertaken. Some recommend operating im- 
mediately after the injury, while others counsel delay until the 
lacerated tissues have sloughed away and granulation is estab- 
lished over the entire wound surface. In this the operator 
should be guided somewhat by circumstances. If called im- 
mediately, before a serious infection of the wound accompanied 
by great swelling has taken place, we consider it preferable to 
operate at once. 

If the operation has been delayed until the wound margins 
have healed, it becomes necessary to entirely denude them of 
epithelium. 

Prior to undertaking the operation, the alimentary tract 
should be thoroughly and completely evacuated, so that there 



Rupture of the Perinetmi 86i 

may be no necessity for the passage of feces over the freshly 
closed wound. Such unloading is best accomplished with re- 
peated small doses of eserine or arecoline. A mare of medium 
size may take 0.75 to i grain of either alkaloid, which should be 
repeated every 45 to 60 minutes until the intestines are appar- 
ently completely empty. 

The vulva, anus, perineum, buttocks and tail should be 
thoroughly scrubbed with hot water, soap and brush for half an 
hour or more and bathed thoroughly with ether to dissolve the fats 
in the skin. The parts should then be thoroughly scrubbed with 
a hot i-iooo corrosive sublimate solution for 15 to 30 minutes. 
This should be completed before casting the patient or placing 
her on the table. 

The animal is to be placed in lateral recumbency, for which 
purpose the operating table furnishes by far the best means and 
places the patient in the best possible position for the conveni- 
ence and efificiency of the operator. If a table is not available, 
the patient may be secured upon an improvised platform of 
boards or straw, and sufficient elevation acquired to render the 
operation field available. 

The patient is then to be placed under complete general anaes- 
thesia with chloroform or chloral. Local anaesthesia does not 
fully answer, because the animal will resist the confinement and 
interfere with the operation even in the absence of surgical pain. 

The vagina and rectum are to be thoroughly washed and dis- 
infected. The rectal and vaginal mucosa will not withstand 
concentrated disinfectants, without inducing an irritation which 
will later cause swelling and straining. The operator should 
accordingly do much of the cleansing by means of irrigations 
with warm normal salt solution, followed by copious irrigations 
with a I % solution of carbolic acid, creolin or lysol. The weak- 
ness of the disinfecting solution needs be counterbalanced by 
careful and extended application. 

The tail should be completely enclosed in an antiseptic band- 
age, and securely tied out of the operator's way. Antiseptic 
towels or cloths should be spread in abundance over the but- 
tocks and thighs, and secured in position by means of safety- 
pins. The table or floor just beneath the field of operation 
should also be carefully covered with antiseptic towels or gauze. 

These precautions having been taken, the vagina and rectum 



862 Veterinary Obstetrics 

are to be carefully wiped drj^ with sterile gauze. If the opera- 
tion is upon a fresh case, any necrotic or maimed tissue fragments 
are to be carefully excised with scissors. If the case is an old one 
and the wound margins are covered with epithelium, this must 
be carefully and completely removed. 

The recto- vaginal cloaca is to be widely dilated by means of 
retractors, and the recto-vaginal walls upon either side of the 
wound grasped with double tenaculum forceps and drawn back- 
wards as far as possible, bringing them essentially external to the 
vulvar lips. 

The sutures maj^ be applied by any reliable method. A good 
plan is to take heavy braided silk sutures about two feet in length, 
armed at either end with a full-curved needle. Carry one of the 
needles into the rectum and, if the operator is right handed, 
insert the needle into the right side of the recto-vaginal parti- 
tion about Yi^ inch from the anterior end of the wound and an 
equal distance from its lateral margin. Pass the needle down 
to but not through the vaginal mucosa, carry it across, insert it 
in the opposite margin of the wound between the vaginal mucosa 
and muscular tissue, carry it up through into the rectum at 
a point opposite the entrance on the left side, and remove the 
needle. Insert the other needle in the same manner about % 
inch posterior to the first, and pass through the tissues and back 
into the rectum in the same way. Tie the extreme ends of the 
suture together, and have an assistant hold it upward out of the 
wa5^ 

Apply a second suture in the same manner, and repeat until the 
posterior or external end of the wound is reached. Drop all the 
sutures along the floor of the rectum, or have an assistant hold 
them aside. Divide the first suture by clipping away the knot, 
and then close the engaged portion of the wound by drawing the 
sutures gently and tying. Do not draw the sutures too tightly, lest 
they cause necrosis, infection, swelling and tearing out. Repeat 
the process with each succeeding suture. 

After the sutures have all been tied, and the ends clipped 
away, begin at the anterior end of the wound, and applj' a con- 
tinuous suture close to the margins to secure accurate apposition. 
The wound margins on the vaginal side should be closed by 
accurate continuous sutures in the same manner as the second 
suture in the rectum. 



Vesico- Vaginal Fistula 863 

The external wounds are then to be closed by appropriate deep 
interrupted sutures. Because of the great danger from suture 
infection in this part, the sutures, before introduction, should 
be thoroughly saturated with a disinfectant, preferably by im- 
mersion of the sutures for a day in tincture of iodine. The ex- 
ternal sutures may be rendered safer by applying to each, after 
insertion, a drop of the tincture of iodine. 

When the suturing has been completed, the rectum and vagina 
should be carefully wiped with sterile cotton or gauze, and the 
wound line, especially in the rectum, liberall}' sprinkled with 
iodoform. 

When recto-vaginal fistula exists, the operation is analogous. 
The sutures are to be made in the same manner. The anus 
should be widely dilated with retractors, and the margins of the 
fistula grasped and dra'Wn out through the anus. 

The after-handling of the wound is highly important. The 
chief concern of the operator is the prevention of the befouling 
of the wound by means of contact with the fecal matter, followed 
by swelling, infection and tearing out of the sutures. The ani- 
mal should not be allowed any solid food, but may have gruels 
or liquid foods, especially milk. The bowels may be largely 
blocked up, and the passage of feces into the rectum decreased, 
by small doses, Yi to i gr. of morphia repeated every 3 or 4 hours. 
The expulsion of such feces as may gain the rectum should be 
facilitated by injections of warm antiseptic solutions, especially 
of weak solutions of lysol or of a weak carbolized oil warmed to 
the temperature of the body. 

The handling of the third group of injuries to the perineum, 
the external lacerations which do not divide the sphincters, offers 
nothing special, and consists in the closure of the wound by 
means of sutures, in accordance with general surgical principles. 

15. Vesico- Vaginai, Fistula. 

Fleming, citing Dupont, records an instance of vesico-vaginal 
fistula, but fails to give exact data in regard to it. Rupture of 
the bladder in an ordinary case of birth, due to the passage of 
the fetus over it, is improbable, since normally the bladder is 
completely emptied before the fetus enters the birth canal, and 
the empty organ lies in a depressed and smooth area upon the 
pelvic floor, covered over by the floor of the vagina. Should 



864 Vetermary Obstetrics 

there be present, within the bladder, a calculus or tumor, the 
danger to the viscus would be very great. Should the floor of 
the vagina and the upper wall of- the bladder become verj' severely 
contused, and the two adhere, there might well occur a sloughing 
of the injured portions, and eventually an artificial communication 
between the bladder and the vagina. Chronic purulent cystitis, 
see page 900, which is not a very rare disease in the mare, fol- 
lowing vaginitis and other maladies, should not be mistaken for 
vesico-vaginal fistula. 

The handling of vesico-vaginal fistula should be based upon 
general surgical principles, adjusted to each individual case. 
The fistula cannot be overcome unless the urethra remains open. 
In such a lesion, as a general rule, there would be, in addition, 
a chronic, purulent cystitis, with an accompanying precipitation 
of the urinary salts upon the walls of the bladder, causing the 
latter to become very greatly thickened and paretic, while they 
give to the finger the sensation of being covered with fine sand 
which has formed into crusts. This condition needs be overcome 
by repeated irrigations with warm water, with possibly very mild 
antiseptics as recommended on page 900. 

16. Hematoma of the Vulva. 

During or about the period of parturition, there occasionally 
appear in the vulva more or less extensive hematoma, due to the 
rupture of blood vessels, causing a hemorrhage beneath the 
mucous membrane in the loose connective tissue. 

The date of their appearance varies. In one instance we noted 
a hematom of considerable size in a mare, following parturition, 
in which no dystokia had occurred so far as was known. In a 
second instance we noted the development of a hematom which 
contained about J3 pound of coagulated blood, in a mare not yet 
due to foal. In this animal there had been a somewhat severe 
colic, which had continued for 18 or 20 hours with some tympany, 
but she had not rolled violently and it was not known that she 
had received any injury. The owner had made a manual ex- 
ploration of the vagina, but apparently had done nothing which 
might cause the hematom to form. The great vascularity of the 
part just prior to parturition tends to favor such lesions upon 
very slight provocation. In one of these cases the hematom oc- 



Hema{o7>ia of the Vtdva 865 

curred along the floor of the vulva near the median line : in the 
other it was well up along the side of the organ. 

The sjmiptoms are verj' characteristic when the blood has be- 
come collected in a large mass, because it pushes the mucous mem- 
brane outward into the cavity of the vulva, so that the volume 
of the tumor projects beyond the surface of the surrounding tis- 
sues and may become pedunculated or pear-shaped. It may pro- 
ject quite beyond the lips of the vulva, especiallj^ when the ani- 
mal is lying down, and may usually be seen very well b}' parting 
the lips of the vulva with the hands. Upon palpation the tumor is 
comparatively soft and painless. When so situated that it can 
be seen, it is observed to be of very dark color, which indicates its 
character. 

It is important to make a clear differential diagnosis of 
hematoma. In one of our cases the tumor was distinctly pedun- 
culated, and so extensive that it protruded be3^ond the lips of 
the vulva whenever the animal was lying' down, and it was so 
near to the median line and immediately in the neighborhood of 
the meatus urinarius that it was at first mistaken for the everted 
bladder. Further examination revealed the meatus, and estab- 
lished the fact that the bladder was in its normal position. 

In some cases there may be a very general extravasation of the 
blood into the tissues, over a large area. This we frequentlj' 
meet with in practice, where dystokia has existed, especially if 
rudely handled by la3'men or empirics, and the vulva and vagina 
greatly abraded and irritated b}^ rough hands and apparatus, or 
with hard, rough cords. Such extravasations are not of a char- 
acter generally to cause serious trouble, but are after a time 
absorbed . 

The handling of hematoma usually consists merely of making 
a free opening through the mucous membrane and pressing out 
the blood clots, after which the vulva should be cleansed with 
an antiseptic solution. In our experience it is eas}' to thrust a 
finger through the mucous membrane, and thus produce an 
extensive opening, which will not adhere and retain discharges 
later. This method of evacuating the blood coagula has an 
element of safety in it, because there is no danger of wounding 
an}' blood vessels which bj' chance may be displaced because of 
the lesion. ' 
55 



866 Veterinary Obstetrics 

Fleming advises scarifications in cases of extensive extravasa- 
tions, though he admits that Cartwright had an unfortunate 
experience through the wounding of a large vein. Apparently 
in this instance he was dealing with a general extravasation of 
blood in the connective tissue, and here of course a single 
puncture or division of the mucous membrane would not permit 
the escape of the blood. As a general rule, in these cases, the 
extravasated blood will be safely resorbed by the tissues, if they 
are given that opportunity. Scarifications, on the other hand, 
open an inviting avenue for serious infection. The}' had best be 
omitted and, in their stead, careful cleansing and disinfection 
maintained until resorption occurs. 

17. Relaxation of the Pelvic Symphysis. 

Fleming, citing Gillis, records one instance of what was diag- 
nosed as relaxation of the symphysis of the pelvis, as a 
consequence of parturition, but the diagnosis was not verified 
by post-mortem examination or by other conclusive evidence. 
In this case a cow had some difficulty in expelling a calf, after 
which she could scarcely rise when down, or walk when upon 
her feet, and her hind quarters swayed from side to side. The 
sacro-iliac articulations appeared to be tender. When the ani- 
mal was moved, there seemed to be some motion in the ischio- 
pubic symphysis. The condition remained permanent, and the 
animal was prepared for the butcher. 

18. Contusions of the Lumbo-Sacral Nerves. 

The lumbo-sacral plexus of nerves is so disposed, in domestic 
animals, that certain trunks are somewhat subject to impingment 
between the bony walls of the pelvis and prominent, unyielding 
portions of the fetus, hy which they may become more or less 
seriouslj' contused and their functions interrupted. The prob- 
ability of these nerves becoming injured during parturition is not 
alike for all the trunks, the gluteal and obturator nerves being 
especially exposed, where the}' pass over the articular eminence 
between the last lumbar and the first sacral vertebrae, while the 
obturator nerve again becomes exposed to injury as it rounds the 
margin of the obturator foramen. See Fig. i, page 4. 



Co7itiision of Gluteal Nerves. Gluteal Paralysis 867 

a. Contusion of the Gluteal Nerves. Gluteal 
Paralysis. 

We have observed, in two cases in draft mares, paralysis of 
the gluteal muscles, followed by atrophy consequent upon par- 
turition. In our observations neither case was referable to dys- 
tokia, in the ordinary acceptation of the term, since birth took 
place without aid and, so far as known, without observable diffi- 
culty. The mares were in prime condition ; no injury or infec- 
tion was externally visible ; there was no fever or loss of appe- 
tite or flesh. Yet, when the mare was down it was difficult for 
her to get up, and when up she walked with an unsteady gait. 
In one case the paralysis was unilateral, and consequently the 
difficulty experienced in rising was not great. When moved she 
had a very distinct paralytic limp in the affected limb. After a 
few days the muscles of the gluteal region commenced to atrophy 
rapidly, which continued to an extreme degree, but the paralysis 
soon subsided, although there was a certain deficiency in the 
strength of the part. After the lapse of several weeks the mus- 
cles began to recover their volume, but the recovery was very 
slow, and nearly a year elapsed before the parts resumed their 
normal appearance. 

In the second case the paralysis was very profound and notable, 
because both hind limbs were involved and it was necessary for 
a time to aid the mare somewhat when she attempted to get up, 
although once she had gained her feet she could walk about with 
some difficulty. The paralytic symptoms subsided in the course 
of two or three weeks, while the atrophy was extreme and the 
restoration of the muscles was very slow, though eventually 
complete. 

The handling of contusion of the gluteal nerves must depend 
fundamentally upon the general care of the animal, since there 
is nothing very direct to be accomplished, nor is it probably nec- 
essary as a rule that anything definite should be done. The an- 
imal should not be permitted to struggle in getting up, or other- 
wise exert herself violently in a manner to increase the injury 
to the nerves and muscles, but should be watched rather closely 
and guarded against further injury. To this end she should 
have comfortable quarters, and her stall should be so managed 
that she will have the best footing possible in order to avoid any 



868 Veterinary Obstetrics 

slipping in attempting to rise. Furthermore, it is desirable, as 
far as practicable, to aid the animal by lifting upon the tail 
whenever she wishes to get up, unless she can accomplish the act 
unaided with comparative ease and safety. Slings may be ap- 
plied should conditions require, but it is preferable to avoid 
them. Should indications warrant it, the veterinarian may 
apply electricity by placing one of the poles of the battery over 
the lumbar region and moving the other over the surface of the 
atrophied gluteal muscles. 

According to our observations, the prognosis is highly favor- 
able. The paralysis disappears in the course of a few days to 
two or three weeks. At the same time the atrophy is increasing, 
but from this the animal teuds to recover completely in from 6 
to i8 months, and in the meantime may do light work if desired. 

b. Contusion of the Obturator Nerves. Obturator . 
Paralysis. 

The obturator nerve is subject to injury from the fetus, at its 
point of passage over the eminence of the lumbo-sacral articula- 
tion and again at the point where it rounds the lip of the obtur- 
ator foramen. 

The symptoms of this accident are acute and unique. The}' 
consist essentially of a loss of power in the obturator group of 
muscles, which include all of the adductors of the limb — the ob- 
turator externus, the adductors of the thigh, the pectineus and 
the short adductor of the leg. 

It matters not, so far as symptoms are concerned, if the nerve 
is injured at its point of emergence from the spinal canal or of 
its disappearance through the obturator foramen. If one nerve 
only is contused, the animal is able to progress with some diffi- 
culty, but the affected limb is held iu extreme abduction, though 
the power of bearing weight or of advancement is not interrupted. 
In advancing the limb, it is brought forward in extreme abduc- 
tion, and is placed upon the ground some inches laterally to the 
normal point of bearing. 

If both obturators are simultaneously injured, the symptoms 
assume an entirely different phase. Both limbs now become 
sharply abducted, the animal is unable to support its weight, the 
two hind feet slip apart, and the animal drops upon its pubis. If 
assisted to its feet, and the hind limbs are held in adduction, the 



Contusion of Obturator Nerves. Obturator Paralysis 869 

animal can stand without diflSculty, but the moment it raises one 
foot the two slip apart again and the animal falls. 

In one case occurring in the clinic of the New York State Vet- 
erinary College, a mare had foaled apparently naturally, but im- 
mediately afterward it was seen that in walking she carried the 
leg in extreme abduction, so that it was exceedingly difficult for 
her to walk. The condition had existed for about a year before she 
was presented at our clinic. We promptly diagnosed injury to 
the obturator nerve upon the affected side. She still walked 
with the affected liinb in extreme abduction, while the muscles of 
the inside of the thigh were greatly atrophied. As we believed her 
incurable after so long a duration, she was destroyed, and a post- 
mortem examination revealed all the muscles supplied by the in- 
jured obturator nerve, very pale and greatly atrophied, so that 
their volume was only about '3 that of the corre.sponding muscles 
of the opposite .side. The other muscles of the limb were normal. 
The obturator nerve was apparently normal, except at its point 
of disappearance in the obturator foramen, where there existed 
a very distinct enlargement, consisting chiefly of connective 
tissue, as shown in Fig. 140. 




Fig. 140. Contusion of Obturator Nerve. 
I, Ilium. Is, Ischium. P, Pubis. ON, Obturator nerve. 
O, Obturator foramen. 1 . Inflammatory induration of obturator nerve. 



Syo Veterinary Obstetrics 

In a second case, observed in our private practice, an imported 
French draft mare, aged four years, had given birth to her first 
foal without difficulty, but was unable to get up. Having been 
called, we placed slings under the patient and helped her to her 
feet, but she could not stand on the hind limbs because they im- 
mediatelj' parted and she tended to drop upon her pubis. If a 
man would hold the feet in adduction, she could stand without 
difficulty. The slings were properljr adjusted and the two hind 
feet tied together, after which she stood comfortably and with- 
out difficulty. After three days, upon the removal of the 
slings, it was found that she could walk with but little difiiculty. 
She made a rapid and complete recovery. 

The handling of contusions of the obturator nerve should con- 
sist of the application of slings, and the feet should be tied to- 
gether to prevent abduction. Later, electricity may prove use- 
ful, one electrode being applied over the loins, the other to the 
inside of the thigh. 



PUERPERAL INFECTIONS. 

During the puerperal state, the great vascularity of the entire 
genital system, combined with the denudation of all that portion 
of the uterus occupied by the placenta, and the almost inevitable 
abrasions and lacerations of some of the parts, tends very strongly 
to lead to infections of a more or less serious character. The de- 
tachment of the fetal from the maternal placenta leaves a vast 
denuded surface, which, in relation to infection, is somewhat 
comparable to a wound. If to this is added wounds, contusions 
and abrasions, of a more or less extensive character, the tend- 
ency to infection is still more increased. 

In the .separation of the placenta there is inevitably some escape 
of blood and other fluids into the uterine cavity, which, if not 
promptly expelled, act as foreign bodies and invite infection in 
the part. If the placenta for any reason fails to become detached 
and expelled at the proper time, it inevitably undergoes decom- 
position and leads with certainty to a greater or less degree of in- 
fection of the uterus and vagina, with possible involvement of 
distant parts and the general system. Added to all this, when 
dystokia occurs and the animal is weakened , the genital organs 
are debilitated, do not contract and close as they should, and 
infection is directly carried into the uterus by the ignorant or 
careless operator, upon the hands, instruments or apparatus. 

It is consequently not so much to be wondered that infection 
frequently occurs during the puerperal state, but rather that such 
infection does not occur with greater frequency. Infections re- 
ferable to the puerperal state are consequently of the greatest 
possible varietj' in intensity, location, character and symptoms. 
It is difficult to draw definite lines between the various forms, 
nor is it possible to describe all forms of infection. We shall 
endeavor to describe only those of leading importance, which 
offer some special train of symptoms, and permit of classification. 
They all trace to the one common source — the entrance of infec- 
tion into some part of the genital tract during the highly sus- 
ceptible puerperal state. From the genital tract the infection 
may extend to neighboring or distant parts, or involve the entire 
system in more or less grave disease. 

871 



872 \^eteri7iary Obstetrics 

1. Acute Metritis. 

Foremost among the puerperal infections, from the standpoint 
of frequency and seriousness, stand the acute infections of the 
uterus. The infection may involve simply the mucous mem- 
brane of the uterus, to constitute endometritis.- When involv- 
ing only the mucosa of the organ, it may be largely or wholly 
confined to the placenta. In the mare, so long as the infection 
is confined to the mucosa, it is also limited to the placenta, and 
might therefore be called placentitis with equal propriety. In 
endometritis of the cow, with her multiple placentae, the infec- 
tion may be confined chiefl}' or wholly to the placentse or that 
part of the mucosa which goes to elaborate the placentse. Here 
again we might justly apply the term placentitis, but in this 
instance it is probable also that those portions of the mucosa 
between the cotyledons may become involved to some extent, 
constituting more strictly au endometritis. 

If the infection is of such virulence that it passes beyond the 
mucosa and, penetrating the muscular walls, involves the peri- 
toneal surface of the uterus, thus including the entire uterine 
wall, we designate it as metro-peritonitis. The difference in 
designation is consequently one intended to indicate the degree 
of extension and the consequent difference in the gravity of the 
disease. 

The causes of acute metritis consist of any of those elements 
which may favor the introduction into the uterine cavity, and 
the growth there, of disease-producing bacteria. 

Standing at the head of causes of metritis, is the retention of 
the fetal envelopes. Whenever the normal period at which these 
should become separated and expelled has passed by, without such 
expulsion, they immediately constitute a source, of danger for 
the well-being of the animal. They promptly cease to constitute 
a part of the living tissues, the circulation of blood within them 
ceases, and they furnish a favorable medium in which bacteria 
may multiply. In most cases the membranes extend from the 
uterus out through the vagina and vulva, where they become 
soiled with feces and other highly infected material, and consti- 
tute an open highway, along which the bacteria may rapidly 
travel as well as multiply, until they reach the uterine cavity. 
The presence of the membranes keeps open the cervix of the 



Acute Aletritis. 873 

uterus, and prevents to a large degree the uormal involution of the 
organ. Added to this, the interference with the retained mem- 
branes, with a view to their removal, by laymen, empirics or 
other incompetent persons, serves to intensify the danger of 
infection by wounding and abrading the organ. 

In the mare, where endometritis is by far the most common 
form of puerperal infection, the disease is generally attributable 
to the fragmeutal retained placenta, already described on page 
810. 

Another very fruitful cause of metritis is the introduction of 
infection into the cavity of the organ, upon the hands, instru- 
ments or apparatus of the veterinary obstetrist during the over- 
coming of dystokia or other manipulations of the organ. The 
frequency with which metritis following dystokia occurs in ani- 
mals constitutes a severe criticism upon the usual methods em- 
ploj'ed by veterinary' obstetrists. 

Wounds of the organ during manipulations of any kind greatly 
facilitate the entrance into the tissues of any infection which may 
gain admission to the uterine cavity. 

The pre,5ence of a dead fetus, which is undergoing putrid de- 
cornpo,sition in the uterus, inevitably causes a more or less se- 
rious metritis. In some instances, where the death of the fetus 
is comparative!)' recent and the putrid decomposition has not pro- 
gressed far, the degree of metritis may be comparatively unim- 
portant, or ma5' even pass unnoticed. In other cases, where the 
putrid fetus has remained in the uterus for a longer period of 
time and the decomposition has become quite complete, the in- 
flammation of the organ is correspondingly great and serious. 
After a long period of fetal decomposition, the uterine walls 
may finally assume the characters and functions of abscess walls. 

When the fetus dies in the uterus and does not become decom- 
posed, but undergoes mummification instead, it does not tend to 
induce inflammation of the organ. 

Tardy involution of the uterus constantly tends to invite in- 
fection. When the uterus does not promptly close, and its walls 
fail to quickly come in contact with each other, there is proba- 
bly a similar tardiness in the contraction of the vagina and vulva, 
so that the entire tract remains somewhat freely open, inviting 
infection. The debility of the organ, of which the tardy involu- 
tion is but a symptom, decreases its power of resisting the infec- 



874 Veterinary Obstetrics 

tion. When the organ undergoes normal involution and contracts 
vigorously, that vigor in itself acts largely to prevent or over- 
come infection. 

Exposure to cold or wet has also been claimed to act as a causa- 
tive agent in metritis. It no doubt occupies an important, though 
indirect place. Any sudden chill, or disturbance of the bod}' in 
general, weakens and depresses the highly sensitive genital tract, 
and renders infection far more probable than though the animal 
were kept under more favorable conditions. 

For convenience the various types of metritis may be con- 
sidered separately. 

a. Acute Endometritis in the Mare. 

Inflammation of the mucosa of the uterus may develop in the 
mare very promptly after giving birth to a foal. Should the 
foal perish and be retained in the uterus to undergo rapid putrid 
decompo.sition, there maj' be present within 24 hours a well- 
marked endometritis, which seriously complicates the handling 
of the dystokia. 

Many cases of endometritis in the mare, do not follow dys- 
tokia, but result from the retention of a fragment of the fetal 
placenta in the non-gravid horn, as already described on page 
810. In such cases infection quickly takes place, and, within 
24 to 48 hours or slightly longer after the expulsion of the 
fetus and of the principal volume of the fetal membranes, 
there appears first of all a well-marked stiffness in the gait of 
the animal, with some disinclination to move and very marked 
tenderness of the abdomen upon pressure. The pulse maj^ be 
normal or somewhat quickened ; the temperature is slightly 
elevated ; and the respiration is somewhat impeded because of 
the abdominal tenderness. The mare may assume the recum- 
bent position much of the time, or she ma^- persistently stand. 
The appetite is variable, and sometimes remains fairly good, but 
is usually depressed. 

The lips of the vulva are usually swollen, and from the genital 
tract there issues a somewhat thin, reddish-gray, dirty, floccu- 
lent discharge, which may be more or less fetid. If the lips of 
the vulva are parted, the mucous membrane is seen to be in- 
jected and irritated. If the obstetrist will introduce his hand 
into the uterine cavity, he will usually find it filled with a dirty, 



Acute Endometritis in the Mare 875 

flocculent discharge of the same character as that which is ob- 
served flowing from the vulva. The amount of the accumula- 
tion in the uterus is extremely variable ; there may be but two 
or three quarts, or there may be 4 or 5 gallons. The walls of 
the uterus are paretic, so that they are unable to force the ac- 
cumulated discharge out of the uterine cavity, and thus permit 
the great accumulation. Upon palpation, the walls are found to 
be dense, swollen and very thick, giving the examiner the im- 
pression of a diameter of }^ inch or more. 

Examining the non-gravid cornu carefully, the obstetrist will 
frequently identify in it a retained piece of the chorion ; or this 
retained membrane may have become detached from the cornu 
and passed out into the body of the uterus, where it lies free in 
the accumulated pus ; or it may have escaped through the vulva 
and disappeared. 

In almost all cases of acute endometritis in the mare, there co- 
exists parturient larainitis. The occurrence of this disease as a 
complication is so uniform that it might well be regarded as a 
part of the malady, but since it is usually described separately 
we shall follow that custom and take up its consideration later. 

As the disease progresses, and becomes more intense, the pulse, 
temperature and respiration become more markedly involved, 
and the discharge from the uterus increases in volume and becomes 
more fetid. As the laminitis increases, the animal becomes more 
and more unable to move, assumes either the recumbent or the 
standing position, according to individual temperament, and per- 
sistently maintains such position. 

The handling of acute endo-metritis in the mare consists es- 
sentially of the removal from the uterine cavity of any placental 
fragments and accumulated uterine discharges. Special search 
is to be made for the fragment of retained chorion so common in 
the non-gravid horn. 

The accumulated fluids are to be removed from the uterine 
cavity by copious irrigations with warm water, to which a small 
amount of antiseptics, like 0.25% carbolic acid, lysol or bacillol 
or 0.1% permaganate of potash may be added. This will not 
disinfect the uterine contents or uterus, but may serve the pur- 
pose of partially disinfecting the irrigating solution. Two, three 
or more gallons of the solution may be introduced at one time, al- 
lowed to escape, and a like quantity again injected. The process 



876 Veterhiary Obstetrics 

should be continued until the water is expelled clear and odor- 
less. This may require a total of six to ten gallons. 

The plan outlined is mechanical cleansing, in contradistinc- 
tion to chemical disinfection. The enormous volume of viru- 
lently infective discharges is quite beyond the power of any or- 
dinary disinfectant to ove'rcome. If the discharges can be me- 
chanically removed, the aim of the surgeon is fully accomplished 
in so far as that is concerned. The walls are still infected and 
inflamed, and will quickly secrete more discharges. We cannot 
disinfect the walls ; any antiseptic capable of doing this would 
likewise irritate, injure or destroy the uterine tissues. 

The paretic uterine walls do not contract, and the fluid must 
either be forced out bj' the contraction of the abdominal walls or 
must be siphoned out through the irrigation tube. The uterine 
cavity should be left empty, except that Y-z oz. of powdered iodo- 
form may be introduced in a gelatine capsule, the capsule opened, 
and the powder scattered over the surface. 

The irrigation should be repeated one to three times daily, ac- 
cording to indications. Improvement is indicated by decreased 
discharge, disappearance of fetor, and a gradual change from the 
dirty-grayish, flocculent, semi-fluid mass to a transparent, odor- 
less mucus. At the same time the hard, thickened walls of the 
uterus soften and become thinner, the mucosa recovers its normal 
consistence, the walls contract, the uterine cavity decreases and 
the walls come in contact. These changes mark convalescence, 
and warrant the gradual cessation of irrigation. 

The strength of the patient may be advantageously supported 
b)' a free allowance of alcohol or nitrous ether in the drinking 
water. An ordinary sized mare may take two to four ounces of 
either drug, and the dose may be repeated frequently. She may 
take either of them at the rate }4 to i oz. per hour for 24 con- 
secutive hours. Quinine may also be administered in large 
(ounce) doses, once or twice daily if fever is present. 

The handling of the concurrent laminitis will be discussed 
while dealing separately with that affection. 

The prognosis of acute eudo-metritis is highly favorable. 
Properl}^ handled, over 90% recover promptly and completely. 
The mare usually remains fertile. 



Acute Metro- Peritonitis in the Mare 'ill 

b. Acute Metro-peritonitis in the Mare. 

Acute metro-peritonitis in the mare is most frequently due to 
a perforation of the uterine walls during parturition, or to 
lacerations or contusions of the uterine walls, which soon lead to 
necrosis of an area, through which an avenue is afforded for the 
passage of infection from the uterine cavity to the peritoneum. 

The wounds which invite the infection and afford an avenue 
for the entrance of the organisms into the deeper tissues fre- 
quently occur just in front of the pubic brim along the utero- 
vaginal floor, and are apparently often due to the presence of a 
conical bony projection on the symphysis pubis, as indicated in 
Fig. 113b, page 677. The perforation may be direct, but proba- 
\i\y more frequently consists of an irrecoverable contusion and 
maiming of the uterine tissues between an unyielding portion of 
the fetus and the conical projection of the pelvis. The contu- 
sions ma}' also be due to a portion of the fetus becoming impacted 
against the pubic brim and crushing the intervening uterine floor, 
especially during forced extraction with important deviations, as 
already related on page 81S. 

It also results frequently from the intensity of infection of the 
uterine walls, from rough handling during dystokia, from the 
introduction of virulent organisms into the uterine cavity upon 
the hands of obstetrists or others, the putrid decomposition of 
the fetus in the uterus, and other similar causes. 

The symptoms may be preceded by, or include in a measure, 
those of endometritis, already described. lyaminitis, which is so 
often observed in endometritis, is not a common symptom. Thepa- 
tient is stiff and disinclined to move. Pressure upon the abdominal 
walls induces severe pain. Fever and loss of appetite are marked. 
The vulva and perineum are usually swollen. As a general rule, 
vaginal discharge is present, soiling the tail and neighboring 
parts. Manual exploration of the genital tract reveals its walls 
swollen, more or less paretic, thickened and painful to the touch. 
The uterine cavity may contain a variable amount of disease dis- 
charges, thick, flocculent and fetid, as already described in endo- 
metritis. 

The prognosis is extremely grave. Few mares recover from 
the di.sea.se, but usually succumb from gangrene and septicaemia 
in from three to ten days. 



878 Veterijiary Obstetrics 

Treatment is of little avail. lyocally it should consist of irri- 
gations, as already recommended for endometritis on page 876. 
To the warm water may be added 0.5% carbolic acid, creolin or 
lysol. After thorough irrigation, iodoform powder may be scat- 
tered over the uterine floor. 

Internally, quinine, one ounce once or twice daily, or potassium 
iodide in ounce doses, two or three times daily, may be used ; or 
the two drugs may be given simultaneously or alternately. 

The strength of the patient should be supported by large and 
repeated doses of alcohol or nitrous ether, and by repeated mod- 
erate doses of strychnine. If the patient will eat, ample food 
should be allowed of such variety as is usually indicated in serious 
febrile infections. 

c. Acute Metritis and Metro- Peritonitis in the Cow. 

Metritis in the cow is most frequently dependent upon retained 
placenta, especially when such retention is neglected, or still 
worse, when improperly handled, as has already been discussed 
when considering the treatment of retained placenta on page 799. 
The infection is also frequently dependent upon perforating 
wounds, or ruptures, of the uterus due to accidents during par- 
turition such as have already been related on page 818 while con- 
sidering rupture of the uterus. It varies greatly in acuteness. 
In one instance, where an acute placentitis occurred within 24 
hours after dj'stokia, apparently due to infection carried into the 
uterine cavity by the obstetrist, there was a sudden elevation of 
temperature to 106F., with the general symptoms of acute 
septicaemia, the cotyledons were enormously enlarged, tense and 
necrotic. This represents an exceedingly virulent type of metritis, 
more severe than the usual form of the disease. As usually ob- 
served there is elevation of temperature, loss of appetite, absence 
of milk secretion, torpidity of the bowels, dullness, and the 
general symptoms of septicaemia. 

Locally there is observed swelling of the vulva, and upon in- 
troducing the hand, the vulva and vagina are found very hot to 
the touch and tender, and the mucous membrane swollen. 
There is frequent and severe straining, during which usually 
small quantities of a grayish-red flocculent pus are discharged. 



Acute Metritis and Metro- Peritonitis in the Coiv 879 

Mixed with the discharge from the uterus, there are frequently 
observed shreds of the fetal membranes, or necrotic cotyledons 
which have sloughed off. The straining is usually very intense, 
and in some cases well-nigh constant. The cow stands with her 
back arched and the abdomen compressed. She frequently 
grinds her teeth, and in almost all cases shows very great pros- 
tration. When the hand is introduced into the uterus, the 
straining is usually aggravated, and becomes very violent. 

As the disease progresses, the discharge may vary greatly in 
character. Always somewhat muco-purulent, it shows a constant 
variation of the proportion of pus to mucus and of the degree 
of admixture of blood, which induces a change in color and con- 
sistence. In some cases the discharge becomes diptheritic, and 
is expelled in large, tough grayish-white masses. As the disease 
progresses, the cow tends to assume the recumbent position, and 
ere long is unable to get up, as a result of the profound septi- 
caemia. The rumen may become distended with gas. 

Terminations. The course of acute metritis in the cow is 
usually very rapid, and terminates in recovery or death within 
from two to six or eight days. In some cases the disease gradually 
passes into the chronic state, and continues for weeks, months 
or years unless properly handled. 

The mortality is high, exceeding 50%. In the placental me- 
tritis or placentitis, where necrosis of the cotyledons is followed 
by their prompt removal and the thorough disinfection of the 
organ, the prognosis in our experience is highly favorable. 
When, however, we have to deal with the usual type of metritis 
or metro-peritonitis, the prognosis is always exceedingly grave. 

The symptoms upon which our prognosis is to be based resolve 
themselves into two principal groups, general and local. 

The temperature of the animal is not always a reliable index 
as to the state of disease, since when there is extensive septi- 
caemia the body temperature is somewhat erratic and at times 
deceptive, so that, while a high temperature may always be re- 
garded as indicative of a serious state, a low temperature is not 
to be relied upon as indicating a favorable course. In cases of 
very profound septicaemia in the cow, mare and other animals, 
the temperature may be normal or subnormal, but when such is 
the case there is a general depression, coma, or collapse, which 
should place the veterinarian upon his guard and prevent him 



88o Veterhiarv Obstetrics 

from misinterpreting the gravity of the disease by the body tem- 
perature. The general appearance of the animal is of more im- 
portance in determining the probable outcome than is the 
question of temperature. If the animal looks somewhat bright 
and maintains a fair appetite, or the appetite, having been lost, 
shows a tendency to return, such may be regarded as a favorable 
omen. 

Locally we usually can determine more exactljr the course of 
the disease and its probable'termination, by comparing the con- 
ditions from day to day. The tumefaction of the vulva and 
vagina, if it increases, indicates an unfavorable course of the 
disease, which is heightened to a degree if the mucous membrane 
of these passages becomes darker in color and necrotic. If, on 
the other hand, the swelling of the vulva tends to disappear and 
the mucous membrane to assume its normal color, the indications 
are favorable. 

Within the uterus itself we meet with still more definite signs 
as to the course of the disease. If the case is progressing favor- 
ably, the uterine walls are less firm and become thinner ; the mu- 
cous membrane gradually resumes its normal consistency and loses 
its hard and smooth character, to become soft and velvety. When 
the patient is improving satisfactorily, the uterine walls gradually 
regain their contractile power, and the uterine cavity conse- 
quently becomes smaller. The accumulation of disease products 
in the uterine cavity decreases in volume ; the discharge loses its 
fetor and tends to become more and more mucous in character, 
until finally all appearances of pus cease, and the discharge is 
entirely of mucus, so far as the naked eye can observe. 

On the other hand, if the disease is progressing toward a fatal 
termination, the uterine walls become more swollen and paretic, 
while the discharge into the uterine cavity tends to increase and 
become more purulent and fetid, and perhaps darker in color, 
owing to a larger admixture of blood. 

Pathology. When metritis progresses to a fatal termination, 
the post-mortem examination usually shows the chief lesions to 
be in the genital tract, very largely in the uterus itself. Accom- 
panjdng these changes there are general appearances throughout 
the body of a profound septicaemia, followed by very rapid decom- 
position of the body. In fact the decomposition has progressed 
to an unusual degree before death, so that, if an autopsy is made 



Acute Metritis in the Cow 881 

immediately after the animal succumbs, the decomposition of the 
genital tract has already advanced to a very marked degree, and 
involves its peritoneal covering. 

The uterus is usually much thickened, dark colored, and more 
or less necrotic. The necrosis involves not only the mucous 
membrane, but the muscular and peritoneal coats, and even adja- 
cent organs in the abdominal cavity, which have been in imme- 
diate contact with the diseased organ. In the vulva and vagina 
there are frequently encountered necrotic patches of a dark, 
dirty, or greenish color, and the entire tract and its contents 
are usually verj^ fetid. The quantity of fluid in the uterus may 
be comparatively small, or may reach several gallons. 

The greatly thickened walls of the uterus are frequently highly 
emphysematous and very friable. Sometimes shreds of the fetal 
membranes are .still retained, the cotyledons maj' be necrotic, 
and portions of the uterus may be covered with extensive dip- 
theritic membranes. 

The peritoneal covering of the uterus being involved, permit- 
ting the disease to extend thereby to other portions of the 
peritoneum, causes a more or less voluminous exudate into the 
peritoneal cavity. Abscesses may exist in the uterine walls, or 
in the surrounding pelvic connective tissue. 

Whenever metritis is highly virulent, thrombosis of the neigh- 
boring vessels is probable, as a result of the infection extending 
to and involving the veins and lymphatics. Such a condition is 
greatly favored in metritis, because of the fact that, only a few 
hours before, the vessels were very large and contained a great 
volume of blood. The large vessels, which no longer have their 
previous function to .perform, become inactive and vulnerable 
to infection. The thrombi, breaking down and passing along 
the blood vessels, tend to cause einbolisms, in distant parts of the 
body, such as the lungs and the joints. In the latter position 
they may produce pyaemic arthritis. 

The general post-mortem appearances of the tissue and organs, 
other than the genital tract, are those of septicaemia or pyaemia. 
The blood is dark colored, and does not readily coagulate. The 
muscles are pale, friable and soft. The liver and kidneys are 
engorged and soft. The general appearances of the body do not 
offer any special differences from those observed in death fronj 
56 



882 Veterinary Obstetrics 

wound infection ; in fact we are essentially dealing with wound 
infection of a particularly virulent type. 

The infection is usually mixed in character, and offers no dis- 
tinction from that usually' found in acute wound infection. 

Handling. The veterinarian should first of all observe care- 
fully those general rules which tend to prevent the infection. 
As in other operations of a surgical character, accompanied by 
wounds or destruction of the protective epithelium, we know 
that they may be caused without being followed by infection, if 
certain precautions can be, or are, properly applied. We have 
already urged, on page 620, that the veterinary obstetrist should 
rigidly apply the rules of aseptic and antiseptic surgery, and have 
there fully discussed the proper course to pursue. He should 
remember that the introduction of his hand into the genital pas- 
sages of a breeding female, just before, during or after parturi- 
tion, is always accompanied by more or less grave possibilities 
of infection, and consequently that such manual exploration 
should not take place unless there is ample reason for it. 

A retained and decomposing fetus should be removed from the 
uterus as early and carefully as possible, because it must other- 
wise eventually induce metritis. If the fetal envelopes are re- 
tained, they should be carefully handled along the lines which 
we have suggested on page 793, in order that their decomposition 
in the uterus, and the infection of the organ therefrom, may be 
avoided. 

When metritis and parturient fever have become established, 
the gravity of the disease calls for prompt, vigorous and intelli- 
gent handling. The first duty is the cleansing of the uterine and 
vaginal cavities. If there is a large accumulation of purulent 
material in the uterine cavity, its prompt removal is demanded. 
The septic material may be flushed out by overfilling the uterus 
with warm water, as described on page 875. 

It is not essential what antiseptic is used, but highl}' important 
how it is used. Generally speaking, we desire the highest effi- 
ciency with the least irritation. With the uterus in a highly in- 
flamed state, the irritation from antiseptics is not so great as in 
the normal organ, and consequently a comparatively strong solu- 
tion may be used. However, we must constantly rely far more 
upon the mechanical flushing out of the organ and the washing 
away of the micro-organisms and their poisons than upon de- 



Acute Metritis in the Cow 883 

stroying them in the uterine cavity or in the tissues of the uter- 
us, lyarge volumes of weak antiseptic solutions are therefore 
preferable to smaller concentrated ones. During the entire pro- 
cess of irrigation, the operator may add small quantities of anti- 
septics, and thus exert some influence upon the septic condition. 
In our experience we have preferred less than a i % solution of 
carbolic acid. We have likewise used a 0.1% solution of per- 
manganate of potash, with good results. 

After the irrigation of the uterine cavity has been completed 
and the liquid has been expelled or siphoned out, there may be 
deposited in the uterine cavity a liberal amount of powdered 
iodoform. 

The flushing of the uterus should be continued until the walls 
have recovered their contractile power and the purulent discharge 
has been replaced by mucus. 

Internally the treatment should consist chieflj^ of those reme- 
dies which support the strength of the animal, and tend to bring 
about either the destruction of the micro-organisms and their pro- 
ducts, or their prompt excretion from the system. The general 
rules of systemic medication in acute metritis in the mare apply 
also to the cow. Potassium iodide, being highly toxic for the 
cow, should be omitted or given in small doses. 

In metro-peritonitis, and other puerperal infections, various 
anti-streptococcic and other sera have been used and highly 
lauded by some veterinarians, but so far as we have been able to 
determine, the evidence of their value has been what we may 
term circumstantial. 

The rapid elimination of poisonous products may be greatly 
favored, when necessary, by prompt catharsis, but as a general 
rule this should be avoided except in very acute cases, and in- 
stead the excretion by the bowels should be favored by a light, 
laxative diet so long as the patient will eat. If, however, it is 
felt that prompt excretion is essential, our preference is decidedly 
toward the hypodermic cathartics, which will act within an hour, 
and thus not induce a prolonged depression or threaten to cause 
superpurgation. Among these remedies we favor moderate or 
small doses of eserine or arecoline, of such amount as to not cause 
great depression of the animal. 



884 Veterinary Obstetrics 

d. Acute Metritis in the Smaller Animals. 

In the smaller animals the causes and symptoms of acute 
metritis are in the main parallel to those observed in the cow 
and mare, varying of course in their expression, according to 
species. Most small animals, when suffering from acute metri- 
tis, tend to remain in the recumbent position. There is extreme 
prostration, with fever, tenderness of the abdomen and a puru- 
lent discharge from the vulva. The patient shows a disin- 
clination to move, and usually _ gives an outcry of pain when 
pressure is applied to the abdomen. 

Since in the smaller domestic animals the uterus is not so 
readily cleansed b}' flushing, considerable care is necessary in order 
to bring about disinfection, and even then the operation will not 
succeed so well as in the larger domestic animals. In the smaller 
animals, like the cat and bitch, we may insert far into the uterine 
horn, a rubber human catheter, and through this inject the fluid ; 
or possibly a slightly bent metallic catheter might be used with 
even greater advantage, because of the possibility of directing it 
first into one and then into the other horn, and gently flushing 
these out with antiseptic fluids. 

In these animals, if the uterus cannot be disinfected by irriga- 
tion, it may be necessary to resort to hysterectomy, as described 
on page 669. 



2. CHRONIC METRITIS. PYOMETRA. 

Allied to acute metritis, aud frequently following it as a sequel, 
there occurs a chronic inflammation of the uterus, which is 
characterized by suppuration of the uterine cavity, with more or 
less accumulation of pus, constituting pyometra, or in case the 
cervical canal of the uterus becomes completely occluded a large 
volume of pus may be confined within the uterine cavity, to con- 
stitute abscess of the uterus. 

Chronic metritis or pyometra may occur in any domestic ani- 
mal, but has been observed chiefly in the mare, cow and bitch. It 
may appear at almost any period in the life of the animal, and its 
relation to parturition is variable. It occurs almost always in fe- 
males which have previously bred, but the duration of time 
elapsing between the last birth and the appearance of the disease 
is not constant. In some cases, pyometra or chronic metritis 
follows parturition after an interval of a few weeks, or there may 
be a more or less definite acute metritis, which partially recovers, 
to be continued somewhat indefinitely as a chronic, purulent in- 
flammation. 

Anything which may lead to an infection of the uterus, and 
permit it to continue for a long period of time, suffices to estab- 
lish the disease. Anything, therefore, which would debilitate 
the organ or the general system, or which would favor or lead to 
the introduction of micro-organisms into the uterus, would act as 
a cause of the malady. Prominent among the recognizable 
causes of this malady, are' retained fetal membranes and any of 
those causes which operate to bring about acute metritis, as de- 
scribed in the preceding article. 

In many cases manipulatious during dystokia appear to be the 
essential source of an infection, which, though not sufficiently 
virulent to bring about an acute metritis, nevertheless induces a 
chronic suppurative disease of the organ. 

a. Chronic Metritis in the Mare. Pyometra. 

Chronic metritis in the mare has not received that attention, 
from writers upon veterinary obstetrics or gynaecology, which 
its .importance deserves. The affection is not at all rare in the 
mare, and often proves very obstinate when handled by the 



886 Veterinary Obstetrics 

methods which have been in vogue. This affection is by far 
most frequently seen in those mares which have at some pre- 
vious time been bred, and have then been allowed to go without 
further attempts at breeding. It is consequently more common, 
according to our observations, in localities where few horses are 
raised, than in those di-stricts where most mares are regularly 
used for breeding purposes. 

In addition to the general causes of chronic metritis, indi- 
cated above, it is not rare to observe chronic metritis in the mare, 
in cases where, because of apparent sterility, the stallion groom 
has attempted to " open " the uterus with a view to inducing the 
mare to conceive. The groom has forced his dirty hand through 
the cervix of the uterus in a rough manner, wounding the organ 
more or less seriously and depositing in the lacerations or abra- 
sions, abundant infection from his dirty hand. 

The symptoms of chronic metritis in the mare consist usually 
of a general appearance of indifferent or poor health, with some 
emaciation and want of power of endurance. Accompanying 
these systemic disturbances, there usually appears from time to 
time a discharge of pus from the vulva. This discharge is some- 
times constant, and dribbles away, especially when the mare is 
moved rapidly upon the road or when she is lying down. If it is 
at all constant, the tail and thighs will generally be found soiled. 
In many cases the discharge occurs only at very wide intervals, 
and apparently proceeds from the over-distension of the uterus, 
which causes the cervix uteri to dilate and brings about the es- 
cape of a large portion of the contents. In these cases the dis- 
ease behaves somewhat as an abscess. The uterine cavity be- 
comes filled with pus, the cervical canal opens and permits the 
escape of the pus, then closes, and the abscess cavity again be- 
comes distended. Sometimes the evacuation of pus is preceded 
by symptoms of colic, and expulsive efforts. 

The amount of pus which may be discharged at one time varies 
between a few pints and four or five gallons. The contents 
usually present the ordinary appearances of pus from an abscess, 
with the admixture of more or less mucus. In many cases it is 
comparatively free from odor, while in others it is quite fetid. 
It is usually yellowish or bluish-white, or may be of a dirfey, 
grayish color, and in one case was black, somewhat fiocculent^ 



Chronic Metritis i7i the Mare 



and presented to the naked eye the appearance of a disintegrated 
melanotic tumor. 

Upon vaginal exploration, the vagina is usually found to be 
normal, though possibly the mucosa is somewhat irritated because 
of the presence of the pus from the uterus. When the os uteri 
is reached, it is usually found closed, and it may prove exceed- 
ingly difficult or impossible to insert a finger. If the cervical 
canal can be passed, the uterine cavity is found filled with pus, 
and the uterine walls paretic and denuded of their epithelial cover- 
ing. Exploring per rectum, the operator finds the uterus very 
greatly distended, lying inert, and containing from one to several 
gallons of liquid, which fluctuates upon palpation. 

There are few affections which may be confounded in reference 
to diagnosis with chronic metritis. Occasionally we meet with a 
similar discharge from the vulva in case of a very large calculus 
in the bladder, accompanied by purulent cystitis. Other forms of 
purulent cystitis may cause like symptoms, as may also a malig- 
nant tumor of the bladder when breaking down. Chronic vag- 
initis may also be mistaken for this affection, until manual ex- 




FiG. 141. Pyometra in Mare. 
O, O, Ovaries. UC, Uterine comu. U, Uterus. 
CU, Indurated cervix uteri. V, Vagina. 

ploration is made. In Case 3 we record below an instance of ter- 
atologic development of the uterus, which induced symptoms of 
chronic metritis. 

The changes observed iu the uterus consist chiefly of a thick- 
ened and sclerotic condition of the cervix uteri, with extreme 



§§S Veterinary Obstetrics 

Harrowing of the os. The mucous membrane completely loses 
its ordinary character ; ulcerating patches appear ; and, as shown 
in Fig. 141, the cornua become displaced from their normal po- 
sition at right angles to the uterine body, and push forward 
somewhat in the direction assumed by the cornua of the uterus 
of the cow. The normal longitudinal folds in the mucous mem- 
brane are entirely obliterated, and in their place there appear 
numerous transverse ridges in the muscular walls. 

The handling of chronic metritis in the mare must be based 
upon the problem of local disinfection, the principal obstacles to 
which are the sclerotic condition of the cervix uteri and the pare- 
tic state of the uterine walls. The fundamental duty of the 
practitioner is to bring about a thorough dilation of the os uteri 
to such a degree as to permit the insertion of the operator's hand 
into the suppurating cavity. This requires much patience and 
hard work in many cases, but is of such great importance that it 
should be persevered in until fully accomplished. In some cases 
it requires patient endeavor, extending over several hours, to 
dilate the os sufficiently to insert a finger. When this has been 
attained, the uterus can be irrigated somewhat ineffectively by 
passing a tube through the os, injecting a large volume of anti- 
septic fluid, and then siphoning it out by means of the tube 
through which it entered. But the further dilation of the os 
uteri must be completed before recovery can be assured. This 
may be accomplished with the finger and hand of the operator, 
by repeated efforts upon succeeding days. 

The partially dilated os may also be tamponed with antiseptic 
crauze or other material, which, remaining in place for twenty- 
four hours, tends to cause a dilation or softening of the parts. 
A large and powerful uterine dilator may be of great service in 
forcibly dilating the os, rendering it very much easier for the 
operator. 

Once the os uteri is sufficiently dilated to admit freely the 
operator's hand, he is in a position to proceed with the final pro- 
blem of disinfection. With good drainage, the question of a 
choice of disinfectants is not supremely important. Any reliable 
disinfectant will accomplish the end, but it needs be intelligent- 
ly applied, and by the veterinarian himself. It is needless to 
say that the disinfecting solution should be sufficiently volumin- 
ous to fill the uterus two or three times successively, so as to in- 



Chronic Metritis in the Mare 889 

sure the thorough cleansing of the cavity at each operation. The 
flushing of the uterus should occur regularly as often as once a 
da}^ and should be persevered with until success is obtained. 

Among disinfectants, i-iooo permanganate of potash solution 
is highly efficient. We have had good results with a solution 
consisting of carbolic acid, tannin, glycerine and water. We 
have varied the strength of this solution according to circum- 
stances, as related in the cases given below. It is important to 
make the solution as strong as will be borne without irritating 
the organ. It is well to remember that most disinfectants are 
quickly absorbed, and their action ceases. In this respect iodo- 
form offers special advantages. After cleansing the suppurating 
cavity thoroughly with one of the foregoing disinfectants, a 
gelatine capsule containing 5 or 10 grammes or more of powdered 
iodoform may be carried with the hand into the cavity, opened, 
and the powder scattered over the uterine floor. The specific 
gravitj- of the iodoform causes it to drop into the folds and 
irregularities of the mucosa, and prevents its being thrown out, 
while its feeble solubility causes a continued action for a day or 
more. At the same time it acts somewhat as a local anaesthetic, 
and tends to prevent straining. 

When local treatment is begun, there frequently' occurs an 
increased systemic disturbance, due apparently to an accelerated 
absorption of septic material. In order to counteract this it is 
well to administer tonics and antiseptics, such as nux vomica and 
iron, potassium iodide, hydrastis Canadensis, or other agents. 
Still more important perhaps, especially if the pus seems more 
fetid and abundant, the irrigations should be increased to two, 
three or more times daily if essential to cleanliness. 

When the disinfection becomes effective there is decreased sup- 
puration, anj' odor which may have been present disappears, 
the discharge becomes more and more mixed with mucus, the 
mucosa of the uterus becomes normal in consistency, the uterine 
walls become active and approach each other so that they lie in 
contact. 

The mare should be kept directly under the supervision of the 
veterinarian from the beginning of the treatment to its success- 
ful termination, and the handling should on no account be en- 
trusted to an ordinary layman. The treatment should not be 
stopped or relaxed until the recovery is complete. By following 



890 Veterinary Obstetrics 

these lines of handling we have not met with an unsuccessful 
case, while we do not recall an instance where the treatment has 
proven successful when the application of the remedies has been 
entrusted to a layman. 

Upon the question of breeding after recovery we have no 
definite data, but there is the danger that the oviducts may 
occasionally become occluded during the course of the disease, 
and cause sterility. 

The following cases are illustrative : 

Case I. — A mare, aged 15, entered our clinic March II, 1899, because of 
a vaginal discharge. An examination revealed a copious discharge of dirty, 
whitish pus from the uterus. The os uteri was constricted. The uterine 
cavity was first injected with warm water, and later with 1-5000 corrosive 
sublimate solution. On March 12, a horse catheter was introduced through 
the constricted os, and i gallon of pus siphoned out, after which the cavity 
was injected with 1-5000 corrosive sublimate solution. 

This line of treatment was continued until the i6th, when the os and uter- 
ine cavity were tightly packed with gauze saturated with creolin solution. 
On March 23 the os had become dilated, and the uterus had regained its 
power, so that the pack of gauze was expelled. There was no longer an 
appreciable amount of pus in the uterus. On March 25 the packing of the 
uterus was discontinued, and creolin solution was substituted for the corro- 
sive sublimate for irrigating. The suppuration had ceased, and the mare 
was discharged. The treatment had occupied a period of two weeks. 

Case 2. — The patient was a mare aged 9 yrs., weighing about 1,100 lbs. 
She was entered on January 9, 1900, with the history of a vaginal discharge 
since June, 1899, or a period of seven months. She had been served in 
June, 1899, without result. Exploration per rectum revealed the uterus 
greatly distended with fluid. A rubber hoSe was passed into the uterus, and 
5 gallons of pus were siphoned out. A weak solution of creolin was then 
injected into the uterus by gravity, and allowed to escape. The uterine 
cavity was then packed with three yards of cheese-cloth saturated with 2% 
creolin solution. 

On January 10 the same treatment was applied, and 5 yards of cheese- cloth 
were used in packing. The same course was pursued on January 11. On 
January 12 the uterus was washed with creoline solution, and packed with 
gauze saturated with carbolic acid solution, which was left in place until 
January 14, when it was re-dressed. On January 15 the patient seemed 
worse. In order to bring about a more complete dilation of the constricted 
OS, a new plan of packing was adopted. A bag was made of sufficiently 
strong cloth, with a diameter of about 4 or 5 inches and a length of 3 feet. 
It was saturated with creolin solution, sprinkled with iodoform, and then 
oiled, and the closed end passed into the uterus. Through the open end 
there were then passed 3 yards of cheese cloth, partly into the uterus but 
largely in the canal of the cervix. 



Chronic Metritis in the Mare 891 

There was given internally for the five following days i dram of pow- 
dered nux vomica and one-half dram sulphate of copper twice daily. A 
manual examination of the uterine cavity showed that the cornua, in their 
paretic state, tended to become reflexed upon themselves in a way to pre- 
vent good drainage. This difficulty slowly disappeared as the case pro- 
gressed. On January 17 the creoline injection was displaced by 1-2500 
corrosive sublimate solution, and, in addition, iodoform powder was intro- 
duced into the uterus on January 20, 22 and 23. She now improved very 
rapidly. The internal treatment was continued. The mare was discharged 
on the 23rd, convalescent, after fourteen days of treatment. 

Case 3. — A mare, aged 4, weighing about 1,050 lbs., was entered on Janu- 
ary 7, 1901, with the history that she had suffered from a vaginal discharge 
since one year old. The discharge was of a light color, and was dropping 
away continuously, keeping the tail and thighs badly soiled. She had not 
been bred, and had never shown signs of estrum. Upon making a manual 
exploration, it was found that the os uteri was open and the hand could be 
passed through it readily. The right cornu appeared normal, while the 
uterine body, with the left cornu formed a remarkably large, elongated 
cavity. The uterus and cornu had the peculiar property of ballooning, like 
the vagina, under the movement of the hand. 

The case is inserted here because of its unique character. It offered the 
general external appearances of chronic metritis, except that the discharge 
was mucoid in character instead of purulent. The difficulty was evidently 
teratologic in character, and the uterus had developed like the vagina, and 
should physiologically have been considered a part of that organ. 

Case 4. — An imported French draft mare, aged 23, and weighing 
about 1,350 lbs., was entered in the clinic on February 13, 1902, for chronic 
metritis. She had a copious discharge of a thick, fetid pus from the vul- 
va. The tail had a number of small melanotic tumors. The uterus was 
washed with a weak solution of carbolic acid. On February 14 the dis- 
charge seemed somewhat decreased, and potassium permanganate solution 
was used for irrigating. The same was repeated on the 15th. On the 17th 
the uterus was packed with cheese-cloth saturated with iodoform and 
vaseline. On the i8th the pack was omitted, and the uterus was washed 
with a solution of carbolic acid and bi-carbonate of soda, which was con- 
tinued on the 19th and 20th. On the latter date there was but a small 
amount of discharge. 

On the 2 1st the discharge seemed worse. The uterus was washed as 
before. Following the washing, a suppository of iodoform, tannin, vaseline 
and beef tallow was introduced into the uterus. On the 22nd the uterus 
was washed with carbolic solution, and after it had been expelled there was 
inserted into the uterine cavity, and allowed to remain, a solution con- 
sisting of tannin i oz. , carbolic acid i dram, glycerine 4 oz., tepid water 
I pint. This treatment was continued daily until March 3, when the patient 
was discharged practically convalescent, with directions for the owner to 
continue the disinfection of the uterus for seven or eight days. 

Case 5. — A farm mare, aged 11, was entered in the clinic on April 25, 1904. 
She had been owned by the party who presented her for three years. Elev- 



892 Veterinary Obstetrics 

en months prior to entrance she had been taken to a stallion for breeding, 
and when the stallion groom examined her he thought that the OS uteri 
was much constricted. After using considerable force he succeeded in 
passing one finger through the os. Immediately afterwards she was served, 
but did not conceive. Since that time she had regularly shown signs of 
estrum. Six months prior to entrance in our clinic, the owner observed 
intermittent discharges from the vulva, of a thick, white, muco-puruleut 
character. At times while at work, she would discharge a large amount of 
pus, and then for several days the discharge would virtuallj' cease. 
Examination revealed the os uteri rigidly contracted. After repeated and 
laborious attempts we succeeded in passing two fingers into the uterus. 
We introduced a piece of rubber hose into the uterus, and withdrew seven 
quarts of a thick, grayish-white viscid pus. We then washed the cavity of 
the litems repeatedly with i-iooo corrosive sublimate solution, after which 
we introduced some two quarts of the solution into the cavity, and allowed 
it to remain. We then packed the os uteri firmly with gauze. 

Internally we prescribed copper sulphate i — \yi oz., nux vomica 
3 oz. , potassium iodide 5 oz., mixed and divided into twenty-four powders, 
of which two were directed to be given daily in the food. ' - 

During the forcible dilation of the os, the mare strained violently and 
offered considerable resistance. On April 26 the mare was straining a great 
deal, though not very violently. After removing the pack, it was found that 
the OS had dilated but little. The rubber hose was again introduced into the 
uterus, and the cavity thoroughly washed out with a solution of lysol. After 
repeated injections until the siphoned fluid came away clear, we introduced 
into the uterus a solution consisting of tannin i oz. , carbolic acid i dram, 
glycerine 4 oz., water i pint. We then packed the os as tightly as possible, 
after which she strained very violently. She was given one ounce each of 
chloral and powdered ginger, which gave relief. 

On April 27 there seemed to be little progress in dilating the os by means 
of the pack. After thorough disinfection of the parts, the os was forcibly 
dilated until the hand could be passed into the uterus. The uterus and 
horns were found greatly dilated, with thickened, paralysed walls. 
After thoroughly irrigating the cavity with lysol solution, we deposited 
about I dram of powdered iodoform in each cornu, and injected, and al- 
lowed to remain in the uterus, the solution used upon the preceding day. 
We then inserted into the os a gauze bag, which had been stneared with 
iodoform and lard, and followed this by packing the bag as full as possible 
of surgeon's cotton, saturated with corrosive sublimate solution. 

On the 28th we removed the pack, and -found no accumulation of pus. 
The cavity was washed with lysol, after which the solution of carbolic acid, 
tannin and glycerine of the preceding days was repeated. On April 29 ex- 
amination showed that the uterine walls were resuming their normal condi- 
tion and contractile power. The treatment of the previous day was repeated. 
The same treatment was applied on the 30th, and the case was left without 
interruption on May i. Examination on May 2 showed a small amount of 
mucus in the uterus. The treatment of the previous days was repeated. 



Chronic Metritis /w the Mare 893 

Recovery was now rapid, and she was discharged fully convalescent on 
May 7, or thirteen days after the beginning of the treatment. 

Case 6. — A mare aged]i4, weighing about 1,050 lbs., was entered in the 
clinic on October 6, 1904, for poll-evil. During the operation for poll-evil, 
under chloroform, there was a constant discharge of a very fetid black pus 
from the vulva. A rubber hose was inserted into the uterus, and 4 gallons 
of pus siphoned away. Upon the following day one and a half gallons of 
pus were removed, and the uterus was washed with a solution of potassium 
permanganate 1-500. Three of these injections were employed consecu- 
tively, each consisting of 2j4 gallons of the fluid. On the third day the 
amount of pus collected in the uterus had decreased to one quart. The 
treatment of the previous days was repeated. 

The accumulation of pus in the uterus gradually decreased from day to 
day, and became lighter in color. On October 12 the pus had assumed the 
ordinary muco-purulent character in colour and consistence, and was free 
froin odor. 

On the first day there appeared to be some blood clots in the discharge, 
and the highly fetid pus had the appeaiauce of broken-down melanofic tis- 
sue. Microscopical examination of the pus revealed streptococci, and a . 
peculiar fungus which was apparently responsible for the color. 

From the beginning of our treatment the mare had received daily in her 
feed }i oz. of iodide of potash and j-4 oz. powdered nux vomica. On Octo- 
ber 18 the administration of potassium iodide and nux vomica was decreased 
one-half ; the discharge was constantly growing lighter in color ; and the 
pus was being replaced by mucus. 

Diiring the entire course of treatment the os had been very much con- 
. stricted, and each day forcible dilation was attempted, but it was not until 
the 20th that it was practicable to insert the entire hand into the uterus. 
On the 22nd, the potassium permanganate injection was replaced by the car- 
bolic acid, tannin and glycerine solution described in the previous cases. 
On October 24 the same treatment was repeated, with the addition of one 
ounce of powdered iodoform deposited in the uterus before the injection of 
the disinfecting solution. On October 26 the os was well dilated, there was 
a small amount of mucus present, the uterine walls were contracting, and 
and the patient was convalescent. She was discharged on October 27, after 
twenty-one days' treatment. 

Case 7. — A mare, aged 7, weighing about 1,000 itis. was entered in the 
clinic on October 13, 1904, for chronic metritis. The owner related that she 
had had a very pendulous abdomen for some time and had shown an inter- 
mittent vaginal discharge. She had expelled a considerable quantity of pus 
on the day of entrance. A rubber tube was inserted into the uterus, and 5 
gallons of thick, whitish pus withdrawn. The cervix uteri was hard and 
unyielding, and the os much constricted. The mucosa of the uterus felt 
much thickened. Only two fingers could be passed through the os into the 
uterus. The uterus was washed daily, up to October 20, with a solution of 
permanganate of potash. On October 20 the permanganate of potash was 
discontinued, and in its stead we injected into the cavity a solution consist- 



894 Veterinary Obstetrics 

ing of tannin one ounce, carbolic acid one ounce, glycerine three ounces, 
and water one gallon. This line of treatment was continued until October 25. 

Throughout the course of the treatment, attempts had been made to dilate 
the OS uteri, but had not succeeded, and consequently on October 25 we in- 
serted a uterine dilator, and forcibly dilated the os uteri until the hand 
could almost be passed into it. The os was packed with gauze saturated 
with 2 per cent, lysol. On the following day there was a considerable ac- 
cumulation of fetid pus, and the os uteri was much swollen. The uterus was 
washed with 0.5 per cent, potassium permanganate solution, and the os was 
packed with gauze saturated with lysol solution. On October 27 we suc- 
ceeded in inserting the hand into the uterus. The treatment of the 
previous day was repeated, and continued until November 3, when the 
cavity was injected with corrosive sublimate solution, after which we 
deposited in the uterus half an ounce of iodoform and two ounces of olive 
oil. This line of treatment was now continued, and the case improved rap- 
idly until November 16, when the patient was discharged convalescent. 

Case 8. — A farm mare, aged 21, was entered in the clinic on May 3, 1905, 
for chronic metritis, The owner related that a whitish vaginal discharge 
had been present to some extent for three years. She had given birth to a 
foal in the spring of 1904, since which time the discharge had been much 
increased. The os uteri was dilated so that the hand was readily passed into 
the cavity. The uterine walls were flaccid and thickened. The uterus con- 
tained a collection of fetid pus. The uterus was washed with a 1-2,000 cor- 
rosive sublimate solution. 

Owing to the paretic condition of the uterine walls, there was difficulty in 
expelling the fluid. She was given internally nux vomica and sulphate 
of copper. The case was discharged on the day of entrance, and the owner 
was directed to wash the uterus daily with 1-2,000 corrosive sublimate solu- 
tion. It was later reported that in the hands of the owner the treatment 
proved unsatisfactory and the animal was destroyed. 

b. Cheonic Metritis in the Cow. 

Chronic metritis in the cow occurs chiefly in those animals 
which are closel}' housed, used for dairying purposes, and regu- 
larly bred. 

The causes appear to be chiefly retained fetal membranes or 
improper manipulations during dystokia. It appears to be 
especially common in the granular venereal disease, or granular 
vaginitis. Whether in these cases it results indirectly from re- 
tained placenta as a consequence of the disease, or directly from 
the extension of the disease into the uterine cavity, is not clear. 

The symptoms in the cow consist mainly of a chronic purulent 
discharge, of a dirty gray color, accompanied sometimes by in- 
different health, with loss of condition and decrease of milk. In 
many cases, in addition to these general signs, there is, in the 



Pyornetra in the Bitch and Cat. 895 

cow, a tendency to prolapse of the vagina. Usually' the dis- 
charge occurs while the cow is in the recumbent position, and 
the dirty reddish-gray accumulation is found lying behind the 
patient in the gutter. In cases where prolapse of the vagina 
occurs, the discharge from the uterus may largely pass un- 
noticed. In many cases of chronic metritis in the cow, the dis- 
charge from the uterus is intermittent, may be comparatively 
insignificant in volume, and therefore not readily observed. 

When such a discharge appears at the vulva, or the animal 
seems to be in indifferent health, or is sterile, it is well for the 
veterinarian to make a manual exploration of the uterus and de- 
termine its condition. If chronic metritis exists, the uterus will 
be found enlarged, according to the amount of pus retained 
within its cavity. The amount of liquid within the uterus 
may vary between one pint and 4 or 5 gallons. The os uteri is 
firmly closed ; otherwise the imprisonment of the pus would not 
be so marked. Chronic metritis in the cow constitutes an im- 
portant cause of sterility. 

Handling. The handling of chronic metritis or pyometra in 
the cow must be based upon the same general principles as al- 
ready related in detail for the mare. In the disinfection of the 
organ one may follow the method already suggested for the 
mare, dilating the os uteri and injecting disinfectants into the 
uterine cavity. The problem of dilating the cervical canal in 
the cow is far more difficult than in the mare, because of ana- 
tomical conditions. The treatment consequently requires more 
time and effort than in the mare. 

A second plan for dealing with chronic metritis or pyometra 
in the cow has been proposed by Hess, and already described 
while discussing the subject of sterility on page 224. According 
to Hess, his plan of handling pyometra by pressing out the per- 
sistent yellow body of the ovary, and then applying massage to 
the uterus from before backward, has been followed by gratify- 
ing results. This plan has proven effective in our hands. 

c. Pyometra in the Bitch and Cat. 

In the bitch and cat, pyometra seems most common in those 
animals which have been bred and later excluded from breeding, 
but may occur in animals which have not been bred at all. 

The symptoms are very similar to those already noted in the 



896 Veterinary Obstetrics 

mare and cow, and include a general weakness and emaciation of 
the patient, combined with a grayish-red discharge from the vul- 
va, which stains the bedding. When the uterus becomes much 
distended, the size of the abdomen may be augmented, and the 
enlarged, fluctuating uterus may be recognized by abdominal 
palpation. 

The handling of the disease in these animals is to be based upon 
the same general principles as in the preceding cases, modified 
by differences in the size of the patient and the form of the 
uterus. 

Owing to the smallness of the uterus, and its form, it is well- 
nigh impossible to effectively irrigate and disinfect its cavity. A 
catheter or other tube may be pushed along through the vagina 
into one of the horns, but it can scarcely advance to the apex or 
be introduced at will into the right or left cornu ; nor can the vet- 
erinarian determine, after it has entered one of the cornua, which 
one it occupies. The irrigation with antiseptics is consequently 
indefinite and unsatisfactory. 

Hobday (Vet. Jour., Jan., 1907, page 30) relates that he has 
had favorable results in rare instances by the administration of 
the extract of hydrastic Canadensis, while a solution of the same 
was u.sed as an injection into the vagina. 

Hobday recommends, instead of antiseptic irrigations or inter- 
nal medication, the operation of hysterectomy, because as a gen- 
eral rule the more conservative measures ultimately fail to bring 
about recovery, while hysterectomy in his experience has been 
safe and efficient. The technic of this operation has been de- 
scribed on page 669. 

It is essential to carry out the operation under the strictest 
aseptic precautions, and to this end it is well that the operation 
be performed under general anaesthesia. 

3. Uterine Abscess. 

When chronic purulent metritis is complicated with atresia of 
the OS uteri, there ensues a condition which may be best de- 
scribed as uterine abscess. The line of demarcation between 
chronic metritis or pyometra, described in the preceding article, 
and uterine abscess is not clear. In the former the evacuation 
of the uterine contents is sometimes constant and sometimes 
intermittent. The intermittent character may be due to a 



Uterine Abscess 897 

temporary atresia of the os or the cervical canal, and the 
final discharge of the accumulated fluid may be the result of a 
breaking down of the adhesions in the canal, in a way which 
might be compared to the rupture of an abscess. In some cases, 
however, the atresia or closure of the os is more persistent, and 
brings about a state which cannot be better designated than as 
abscess. 

The causes of abscess of the uterus are similar to those of 
chronic metritis, and are very largely refera^ble to infection fol- 
lowing manipulations during dystokia or to retention of the fetal 
membranes. 

The symptoms of uterine abscess differ from those which are 
typical of chronic metritis. The disease is observed chiefly in the 
mare. The principal symptoms observed are those of general 
debility accompanied by some emaciation and general appeatt 
ances of ill-health, with evidences of abdominal pain, which may 
be described as colic. lyater, expulsive efforts appear. The 
uterine walls serve as abscess walls, and the tension within the 
cavity constantly increases, until finally the walls rupture in the 
direction of least resistance, and the contents escape. So far as 
we have observed, the abscess ruptures into the vagina, appar- 
ently through the occluded os uteri. 

Under these conditions a manual exploration per rectum re- 
veals an enormously enlarged uterus, very tense and fluctuating. 
The uterus may contain as much as 4 or 5 gallons of pus. The 
organ loses its usual form, and becomes more or less .spherical. 

Manual exploration per vaginam reveals a normal vulva and 
vagina ; but the os uteri is absent, and that portion of the uterus 
which normally projects into the cavity of the vagina has be- 
come wholly effaced. The anterior wall of the vagina appears as 
a tense partition, without any opening toward the uterus. 
Through this wall the distended organ may be readily felt, or 
rather we might say that the anterior vaginal wall, with which 
the hand comes in immediate contact, constitutes the posterior 
wall of the abscess cavity. 

In one mare we had considerable diSiculty in overcoming dys- 
tokia. After the fetus was removed by means of embryotomy, 
the mare did not recover with that promptness and completeness 
which should be expected, and finally began to decline. lyater 
57 



898 Veterinary Obstetrics 

she was presented for examiuation because of frequent colicky 
pains and expulsive efforts. Upon manual exploration per 
rectum, the uterus appeared as an immense spherical sac contain- 
ing 5 or 6 gallons of liquid. Upon introducing the hand into the 
vagina, the os uteri could not be definitely recognized, and there 
was no opening extending forward into the uterine cavity. 

The owner hesitated about an operation, and after a few days, 
upon going to the stable in the morning, he found lying in the 
stall behind the mare some 5 or 6 gallons of thick and extremely 
fetid pus. 

Handling. The treatment of uterine abscess shoud be essen- 
tially the same as that for other abscesses. The abscess cavity 
should be freely opened, and its contents evacuated, followed by 
thorough disinfection. The point for opening the abscess is 
through the occluded os uteri. The opening may be made with 
a scalpel, or a finger may be thrust through the wall, if not too 
dense. The opening should be sufiBciently dilated that the hand 
may be passed through into the abscess cavity. The later treat- 
ment is the same as for chronic metritis. 

The prognosis in uterine abscess should be guarded. The life 
of the patient may usually be saved. The abscess tends to cause 
occlusion of the oviducts and consequent sterility. 

4. Vaginitis and Vulvitis. 

Inflammation of the vagina and vulva almost inevitably ac- 
company acute metritis, because the passage of infected and irri- 
tant discharges from the uterine cavity must contaminate the mu- 
cous membrane of these organs in escaping externally. In such 
cases the vaginitis and vulvitis normally disappear when the me- 
tritis recovers. Aside from this we sometimes meet with inflam- 
mation of the vagina and vulva without the uterus becoming in- 
volved. 

Causes. Anything which may cause contusions, lacerations or 
abrasions of the vaginal and vulvar mucosa tends to cause the dis- 
ease, if added to this there is favorable opportunity for infection. 
In dystokia, the manipulations of a careless obstetrist may do 
much to lacerate and abrade the vagina and bring about infec- 
tion of the wounds. Laymen and empirics, as well as some vet- 
erinarians, frequently use old, dirty cords or ropes, made of very 
coarse, harsh material, for carrying out obstetric operations. 



Vaginitis and Vulvitis 899 

These lacerate and abrade the genital passages in a highly repul- 
sive manner, and simultaneously deposit the infection in the 
maimed tissues. Add to these, dirty hands of careless operators 
and the virulent infection from a putrid fetus or fetal membranes, 
and a highly dangerous infection of the vagina or vulva is almost 
inevitable. 

Necessarily no differentiation can usually be made between 
inflammation of the vagina and of the vulva, since these two 
canals are continuous at the time of parturition, and the vagina 
cannot well be involved without the vulva sharing in the disease 
to a greater or less extent, and vice versa. 

Inflammation of the vagina or vulva may lead to suppuration, 
ulceration or gangrene. Necrosis of the lips of the vulva, or of 
the walls of the vagina, may lead to a rapidly fatal termination ; 
or, should the patient survive, the vulvar lips may slough away, 
and more or less atresia of the vulva or vagina result. While 
dealing with dystokia in the anterior presentation, due to the 
extension of the posterior limbs beneath the fetal body, we re- 
lated, on page 778, three cases in which serious vulvitis, vaginitis 
or cystitis followed, one case ending fatally. 

The lips of the vulva, and the mucous membrane of the vulva 
and vagina, become inflamed and swollen. If the lips of the 
vulva are parted, the mucosa is observed to be of a deep red or 
dark blue, or a necrotic greenish-black. Usually there are also 
visible lacerations or abrasions of the mucous membrane, with 
more or less suppuration. The swelling and pain in the parts 
may cause difficulty in defecation or urination. 

The prognosis of vaginitis and vulvitis must be based upon the 
extent and virulence of the infection. Where the necrosis of the 
tissues is not extensive, the prognosis is usually good; but when 
there is extensive gangrene, accompanied by general septicaemia, 
a fatal issue may be expected. In cases of more or less exten- 
sive ulceration or gangrene, without marked septicaemia, there 
may be highly important adhesions or constrictions, which may 
serve to prfevent thereafter the breeding of the animal. 

The treatment of vaginitis consists essentially of disinfection, 
which needs be vigorous and thorough. The attending veteri- 
narian should guard with all possible care against septicaemia in 
cases of gangrene, by the administration internally of quinine, 



900 Veterinary Obstetrics 

potassium iodide or other similar remedies in large doses, in addi- 
tion to vigorous local disinfection. 

In all cases of dystokia where the obstetrist has reason to fear 
vulvo- vaginitis, he should apply strict prophylactic measures, in 
the form of careful and repeated irrigations with warm antisep- 
tics, and the washing of the tail, vulva, anus and surrounding 
parts frequently with reliable antiseptics like 2.5% carbolic acid 
solution. 

5. Cystitis. 

Septic inflammation of the bladder, as a result of puerperal in- 
fection, is not a very common malady in domestic animals. We 
have observed one case in the mare, which we have already briefly 
related at the bottom of page 778. 

After overcoming the dj'stokia, the vagina and vulva were 
cleansed as well as practicable, but the case was neglected and 
not seen by us again for some weeks, when we found severe vag- 
initis, vulvitis and cystitis. The cj'stitis was the rfiost formid- 
able of the lesions. The meatus was open, and the index finger 
could readily be passed into the cavity of the bladder. The walls 
of the bladder were thickened, and the mucosa was thrown into 
extensive folds, which were covered over by crusts of urinary 
salts, mixed with pus. The purulent urine had a very fetid odor. 
The cavity of the bladder was small, and the thickened walls 
paretic and inextensible, so that the urine flowed from the bladder 
involuntarily, producing an intense irritation of the vulva. 
Dribbling down constantlj'' over the thighs, the urine kept these 
parts repulsiveh' soiled and excoriated, and the tail constantly 
wet and filthy. 

The treatment of purulent cystitis consists essentially of 
the disinfection of the vagina, vulva and bladder. Somewhat 
mild and efficient antiseptic fluids, such as a 0.5% solution of 
carbolic acid, or, perhaps better, o.\'/c permanganate of potash, 
should be injected into the cavity of the bladder. On account 
of the precipitation of the urinary salts on the walls of the blad- 
der, it might be well to slightly acidulate the fluids injected into 
the viscus, in order that the urinar}' salts may be dissolved, and 
hence the irritation caused by their presence overcome. The 
disinfection of the vagina, vulva and bladder should be frequently 
repeated, at least once a day, and persisted in until complete 
recovery is assured. 



Peri-vaginal Abscesses 901 

6. Peri-vaginal Abscesses. 

In diflicult labor, much of the violence to the genital tract is 
concentrated upon the vagina and the pelvic portion of the uter- 
us. These parts may be caught between unyielding portions 
of the fetus and the bony walls of the pelvis, and become 
more or less seriously contused, abraded or lacerated. In addi- 
tion to these injuries, the obstetrist may irritate the parts 
in some measure with his hands and arms, and with instru- 
ments and apparatus, especially with coarse cords or straps for 
the exertion of traction. Under these conditions the walls of 
the vagina are liable to become seriously infected. The septic 
material, finding its way deeply into the tissues, eventually in- 
duces the formation of abscesses in the walls of the vagina itself 
or outside in the pelvic connective tissue. More anteriorly, the 
infection of the vaginal walls may cause adhesions between the 
vaginal or uterine peritoneum and the walls of the pelvis, and 
lead to the formation of abscesses between these two layers of 
adherent peritoneum or in the adjacent connective tissues. 

The abscesses occur with greatest frequency, according to our 
observations, along the floor of the vagina in the region of the 
bladder, and, when verj' extensive, press upon that organ and 
interfere with urination. They may so involve the walls of 
the bladder as to cause a rupture of that organ, either into the 
vagina or the peritoneal cavity. The abscesses may rupture 
into the vagina, rectum, or peritoneal cavity. 

The symptoms of peri-vaginal abscesses consist at first chiefly 
of a stiffness in the posterior portions of the body, with a disin- 
clination to move, accompanied by general febrile disturbances, 
including elevation of. temperature, loss of appetite and general 
dullness. The vulva is usually swollen, and upon separating 
the lips, the mucous membrane is usually found to be swollen 
and dark colored. Defecation is painful, if not difficult, be- 
cause of the extreme sensitiveness of the parts, accompanied 
hy more or less extensive swelling. If the abscesses are forming 
between the pubis and the vaginal floor, the act of urination is 
almost inevitably accompanied by pain and difficulty. 

Upon manual exploration of the vagina, the parts are found to 
be very hot and sensitive, while at some point, most probably 
along the vaginal floor, extensive, hard swellings may be felt. 



902 Veterinary Obstetrics 

which, later in the progress of the disease, fluctuate. In a mare 
we observed almost the entire floor of the vagina involved in a 
series of large abscesses, which extended forward as far as the 
pubic brim. The fluctuation could be readily felt. The parts 
were exceedingly tender, and the animal moved with very great 
difficulty. 

The prognosis of peri-vaginal abscesses must be based largely 
upon their location and the possibility or probability of their rup- 
turing or being opened into the vagina or rectum. 

The handling of peri-vaginal abscesses should be in accordance 
with general surgical principles, and should consist funda- 
mentally of opening the abscesses into the vagina or rectum at the 
earliest possible moment. In the instance which we have already 
cited, we hesitated too long to open the abscess, lest we might 
thereby open the peritoneal cavity, and hoped for a spontaneous 
rupture into the vagina, but our delay permitted the abscess 
to rupture into the peritoneal cavity instead. It is hazardous 
to delay opening the abscesses. If they cannot be safely opened 
into the vagina or rectum, then fatal rupture into the peritoneal 
cavity is practically certain. Thorough irrigation of the vagina 
and abscess cavity should be applied daily or more frequently, 
according to circumstances. Internal antiseptics, such as quinine 
and potassium iodide, in full doses, are indicated. 

7. Py.«;mic Infection. 

Aside from the strictly local infections of the genital tract, 
lesions of these organs afford a portal for the entrance of infec- 
tions of various kinds into the system. The infecting organisms 
may gain the lymph or blood circulation, and be carried to distant 
parts of the body, where they may become lodged to multiply 
and produce localized inflammation, with the formation of ab- 
scesses or other changes, to constitute pyaemia. Pycemic in- 
flammations may involve any tissue or organ in the body, and 
consequently may produce a great variety of symptoms. In ob- 
stetric practice we observe chiefly, as pysemic diseases belonging 
to the puerperal state, poly-arthritis or pysemic arthritis, and 
metastatic inflammation of tendon sheaths. 

a. Poly-arthritis may be defined as an arthritis following par- 
turition, and generally involving .several joints, especially the 
tarsal, carpal, and femoro-tibial articulations. No articulation is 



Pycemic Infection 903 

immune. According to de Bruin the disease may have its origin 
in the articular serous membrane or in the bone marrow, and 
may be either serous or purulent in character. It is observed 
chiefly in the cow. 

It is believed that the infection reaches the articulations pri- 
marily by being taken up by the veins from the uterus, probably 
in the form of small thrombi, which, passing to the heart and 
thence to the lungs, succeed in passing through the latter organs 
and gaining the systemic circulation, through which they event- 
ually reach the synovial membranes or marrow of the bone, 
where the micro-organisms lodge and multiply to induce arthritis. 

As a rule poly-arthritis follows some recognizable puerperal 
infection of the uterus, such as retained placenta, or other dis- 
ease, followed by more or less evident metritis or vaginitis. In 
some instances the disease follows an apparently normal puerpe- 
ral period, presumably because some very small wound of the 
mucosa of the genital tract, or other injury, has led to an infec- 
tion which has escaped notice until the arthritis appears. 

The symptoms of poly-arthritis usually appear at about 6 to 8 
days after parturition, though they may be delayed for some 
weeks. They consist chiefly of stiffness in the gait, accompanied 
by more or less distinct lameness and difficulty in getting up. 
Pain is very evident, and the animal assumes the recumbent posi- 
tion for a large part of the time. There is well marked fever, 
with the accompanying symptoms of loss of appetite, cessation 
of rumination and a decreased secretion of milk. An examina- 
tion of the uterus may reveal the presence of retained placenta, 
or of a dark-colored fluid, which may or may not be fetid. 

The pain in the affected limb is so great that the animal de- 
clines to bear weight upon it .so far as avoidable. The capsule 
of the joint is distended and tender. The epiphyses of the bones 
are sometimes swollen and painful. If more than one joint is 
simultaneously involved, the movements of the animal become 
exceedingly difficult and painful. The symptoms may be com- 
plicated by metastatic inflammation, or abscesses of some of the 
internal organs, which may cause edema of some of the depen- 
dent parts of the body. 

The prognosis is variable. If the arthritis is serous in char- 
acter, perhaps we might say if it is due to the irritation of the 
bacterial products in the part rather than to the presence of 



904 Veteri7iary Obstetrics 

the bacteria themselves, the disease may run a favorable course, 
with complete recover}- in a comparative!}' short time. When 
the bone marrow is involved, the disease becomes more serious, and 
a fatal termination is probable, as is also the case when the dis- 
ease assumes a purulent character and abscesses form in or about 
the articular capsule. 

Upon post-mortem examination the synovial membranes of 
the joints are found reddened and thickened, and the superficial 
epithelium destroyed. The synovia is of a dark yellow color, or 
purulent in character, while the tissues outside the capsule are 
infiltrated. Scattered here and there are small purulent cen- 
ters. The articular cartilage may be eroded and destroyed, and 
the epiphyses of the bones may have undergone purulent de- 
struction. 

Handling. Our first care in the handling of the disease should 
be the thorough and repeated disinfection of the genital tract, in 
order to prevent further absorption of .septic material from the 
original source. If the fetal membranes, or fragments of them, 
still remain in the uterus, they should be removed. If some of 
the cotyledons are necrotic, and destined to slough away, the pro- 
cess should be hastened by their removal, and the organ thorough- 
ly irrigated with antiseptic solutions. 

Reliable antiseptics should be applied to the affected articula- 
tions by means of a large pack of cotton, jute or oakum, kept 
constantly saturated with the disinfectant. In some instances 
where the bone is extensively involved, it has been recommended 
to apply the thermocautery in small punctures. When ab- 
scesses form about the joint, they should be treated according to 
surgical principles, though as a general rule they cannot be suc- 
cessfully handled. 

Internally the animal may receive antiseptics, among which 
de Bruin especially recommends camphor and turpentine. 

b. Metastatic Tendovaginitis. Under this title de Bruin 
describes an inflammation of the tendon sheaths of cows during 
the puerperal state, occurring chiefly in the great flexor tendons. 

The symptoms consist of a stiffness in the gait, with evidences 
of pain, accompanied by loss of appetite and of milk secretion, 
and a tendency for the animal to remain in the recumbent posi- 
tion. Examining the animal locally, the veterinarian finds the 
tendon sheaths hot, swollen and tender. The disease may co-exist 



Pyceinic Infection 905 

with poly-arthritis. The prognosis is fairly good if only one of 
the limbs is diseased ; but if all are involved, extreme emacia- 
tion is probable, along with extensive decubitis gangrene. These 
tend to greatly complicate the disease, and render the prognosis 
very grave. Even here, however, prompt and vigorous meas- 
ures may save the life of the animal. 

Handling. The general line of treatment is identical with 
that of poly-arthritis. The uterus should be cleansed and disin- 
fected. The affected tendon sheaths should be enclosed in anti- 
septic packs, which are to be kept constantly moistened. If the 
tendon sheaths undergo suppuration, they should be freely opened 
from end to end upon the median line, and the cavity packed 
with gauze saturated with tincture of iodine, in order to bring 
about at once a thorough disinfection of the parts. Over this 
there should be placed an ample pack of surgeon's cotton or oak- 
um, saturated with a reliable antiseptic. 

8. Puerperal Septic.«;mia. 

Puerperal septicsemia signifies the entrance into the general 
system of septic products, accompanied or not by the bacteria by 
which these products have been formed. Technically a distinc- 
tion is made between septicsemia — by which pathologists under- 
stand the entrance of micro-organisms along with their products 
into the blood, and the continued multiplication of the bacteria 
in the body fluids — and saprsemia or toxaemia — by which is 
understood the entrance into the blood of the bacterial poisons 
only. 

. Clinically the differentiation between septicaemia, bacteri- 
aemia and saprsemia is not easily defined. Yet they present an 
essential difference in prognosis. The condition accompanies to 
a greater or less extent most forms of septic infection of the gen- 
ital tract during the puerperal state, but the intensity of the 
septicsemia is not necessarily parallel to that of the local disease. 
We meet clinically with very extensive septic inflammation of 
the uterus, resulting from a retained fetus undergoing putrid de- 
composition over a period of days, weeks or months, or from re- 
tained placenta undergoing rapid decomposition, during which 
the cotyledons may become necrotic and slough off, while the de- 
gree of septicsemia or saprsemia may be very insignificant. On 
the other hand, there may occur virulent septicsemia in the 



9o6 Veterinary Obstetrics 

presence of comparatively slight discoverable disease of the gen- 
ital tract. 

The disease may follow dystokia or normal birth, and the port 
of entry for the bacteria may consist of wounds or abrasions or of 
the denuded mucosa, resulting from the separation of the pla- 
centa. The organisms may be introduced by the obstetrist or 
other persons upon the bauds or arms ; by means of instruments 
or apparatus, or in various other ways. 

Symptoms. The symptoms of septicaemia are acute. The 
disease is usually ushered in suddenly in from one to four or five 
days after parturition or after the death of the fetus, with open 
OS uteri and decomposition of the uterine contents. The symptoms 
consist chiefly of the general signs of fever, including elevation 
of temperature, cessation of feeding and of rumination, decrease 
in milk secretion, quickened pulse and respiration, with injection 
of the visible mucous membranes. 

Locally there is swelling of the vulva, and when the dis- 
ease is very intense the vulvar lips may become greatly 
tumefied, cold to the touch and blue-black in color. The 
vulvar mucosa is swollen and dark colored, and may show wounds 
or ulcers. The contents of the uterus may consist of shreds of 
placenta, with accumulations of pus of variable color, which is 
usually very fetid. 

The patient generally shows extreme weakness and listless- 
ness. Most animals tend to lie down much of the time. The 
eyes soon become lustreless ; in the cow they may appear swol- 
len. Ruminants may grit the teeth, and moan. 

The bowels are irregular, at one time showing constipation, 
at another a fetid diarrhea. If purgatives are given, especially 
saline, oleaginous or aloetic, superpurgation is highly probable. 

Acute puerperal septicaemia is usually fatal, generally ending 
in death within a few days. It sometimes runs a very stormy 
course. We have observed cases in the cow which have ended 
fatally in less than 24 hours after the advent of signs of disease. 

Pathology. The changes in the genital tract are not always 
in harmony with the profound effect upon the general system. 
A diligent search may fail to reveal very pronounced changes in 
the uterus or vagina. The blood is thin and does not coagulate, 
and the muscles are pale and have the appearance of having been 
cooked. There may be more or less evident metritis, with all 
the changes belonging to that affection. 



Pyamic Infection 907 

The peritoneum shows here and there ecchymoses. Ente- 
ritis may be present. The liver, spleen and kidneys show well- 
marked degeneration, and are somewhat enlarged and friable. 

Handling. All attempts at therapeutics usually fail. De 
Bruin recommends camphor, turpentine and alcohol, but without 
having any faith in their bringing about a cure. He very prop- 
erly places the chief emphasis upon the question of prophylaxis. 
Especially is it important that the veterinary obstetrist should 
take due precautions against acting as a bearer of the infection 
through his person, instruments or apparatus. 

Any animal suffering from septic infection of the genital tract, 
or, for that matter, of any other organs or tissues, should be care- 
fully excluded from the stable and vicinity of parturient animals, 
and there should be no intermediary communication between 
them by which the transportation of infecting material from one 
to the other is rendered possible. 

Whenever a veterinarian is called to attend a parturient ani- 
mal suffering from fever or other systemic disturbance, the 
genital tract, and especially the uterus, should first of all be 
thoroughly examined in order to determine whether it be the 
avenue of a serious infection. 

Should the examination reveal septic utero-vaginal disease, no 
time should be lost in thoroughly cleansing and disinfecting the 
genital tract. 

Time and again the careless veterinarian treats an animal, 
especially a cow, for indigestion, constipation, diarrhea or some 
other symptom of disease, without taking the trouble to examine 
the uterus and learn therefrom that the constipation, diarrhea or 
or other symptom which he is handling is dependent upon a 
serious puerperal infection, which demands prompt and vigorous 
treatment. The handling of these conditions falls essentially 
under " Retained Placenta," page 791, and "Acute Metritis," 
page 872. 

9. Puerperal IvAminitis. Paturient L,aminitis. 

While describing endometritis in the mare we had occasion to 
refer to parturient, or puerperal laminitis. So far as we have been 
able to determine, parturient laminitis occurs in the mare only, 
though there is no reason why it may not occur in ruminants, 
where laminitis from other causes is not unknown. Flem- 



9o8 Veterinary Obstetrics 

ing cites Roloff as having observed a peculiar inflammation of the 
feet of cows just after parturition, though the description which 
he gives does not fully identify it with laminitis. 

Parturient laminitis in the mare is a well-nigh constant accom- 
paniment of endometritis. It is so common that it may be re- 
garded as an essential part of that malady. It is probably 
overlooked sometimes because there are present, in endometritis 
of the mare, two painful areas — ^the abdominal pain due to metri- 
tis, and the pain in the feet from the laminitis, each of which 
induces a stiffness in the gait which is very much like the other. 

The nature of parturient laminitis, so far as we have been able 
to observe clinically, does not differ in any essential respect from 
the laminitis due to irritation of the intestinal tract from indiges- 
tion. It appears to be a purely metastatic inflammation, depend- 
ent directly upon the irritation in the uterus as a result of en- 
dometritis, and the absorption from the uterine mucosa of the 
products of bacterial decomposition. 

The symptoms of puerperal laminitis are identical with the 
symptoms of the laminitis following indigestion. It usually 
occurs in those cases of endometritis in the mare which have 
their origin in a retention of the placenta in the non-gravid horn 
of the uterus. As a rule it follows an apparently normal birth, 
in which the placenta has been expelled promptly, and so far 
as the owner observes, completely, but that portion of it which 
has occupied the non-gravid cornu has been broken off and re- 
tained. In the course of 48 to 72 hours after parturition, there 
appear the general symptoms of endometritis, as already de- 
scribed on page 874. Upon examination, the fragment of 
placenta may still be found in the non-gravid cornu. 

At the same time that the symptoms of endometritis are first 
observed, well-marked laminitis also usually appears. The 
disease ma3' involve the two anterior feet, or all four feet. 
As in ordinary cases of laminitis, the animal moves with great 
diiSculty, and places its weight upon its heels so as to relieve the 
sensitive laminae upon the anterior walls of the feet from pres- 
sure as far as possible. If the disease is very severe, the animal 
tends to persistent recumbency, or stands riveted to the spot and 
can hardly be induced to move. 

Examination of the hoofs reveals a distinct elevation in their 
temperature, varying of course according to the intensity of the 
attack. Throbbing of the arteries of the feet is very evident. 



Puerperal Tefatius 909 

The prognosis of the disease is generally highly favorable, and 
is parallel to the prognosis of the endometritis. In fact the 
two diseases are inseparably bound up together, so that their 
prognosis and handling are essentially identical. lyike laminitis 
from other causes, so puerperal laminitis is largely a disease of 
the draft animal. The prognosis will depend to a degree upon 
the size of the patient. The gravity of the disease increases 
with the weight of the animal. 

The handling of the endometritis we have already discussed 
on page 874, and it is only essential at this time to consider the 
local treatment of the laminitis. There are two plans for hand- 
ling the iniiammation of the feet, each of which has its devotees 
— hot and cold applications. 

We distinctly prefer the application of cold, either in the form 
of water or of ice, and that the application be continuous and 
ample. If the animal is recumbent or can be induced to remain 
recumbent, so much the better, because it relieves the feet from 
the weight of the patient. In the recumbent animal, cold water 
is not readily applied, and consequently one may most con- 
veniently apply ice poultices, renewing them frequently in order 
to maintain constant refrigeration. If the animal can readily 
stand, and will do so, it should be placed in a bath of cold water, 
the temperature of which may be reduced to a low point by the 
frequent addition of ice. The cold water bath should extend up 
to or above the fetlocks, and the floor of the bath should be of 
some yielding substance, so that the entire plantar surfaces of 
the feet may contribute to the support of the weight. The shoes 
should be removed in order to prevent the sinking of the os 
pedis, or the dropping of the sole may be still better prevented 
by the application of special padded shoes, and the weight dis- 
tributed equally over the entire plantar surface of the hoof. 

The internal treatment and the handling of the uterus, which 
have already been discussed on page 875, are quite as important 
as the local applications to the feet. 

10. Puerperal Tetanus. 

In discussing the question of retained placenta in the sheep on 
page 811, and of prolapse of the uterus on page 827, we have 
alluded to the rare occurrence of tetanus as a complication. We 
observed one case of tetanus following retained placenta in a cow. 



gio Veterinary Obstetrics 

Tetanus infection may find entrance into the genital tract under 
still other conditions during the puerperal state, and induce 
typical tetanus. The obstetrist or others may readily introduce 
the bacilli into the genital tract, during a case of dystokia or 
the removal of placenta. Having gained the susceptible genital 
tract, the organisms may there multiply and induce the disease. 
The period of incubation, symptoms, pathology and treatment 
are identical with those of cases of tetanus in which the micro- 
organisms have entered by other avenues. The number of cases 
of puerperal tetanus is small, so that the comparative prognosis is 
uncertain. In the case of prolapse of the uterus mentioned on 
page 827, the mare recovered successively from uterine prolapse 
and from tetanus. 



PUERPERAL ECLAMPTIC DISEASES. 

In domestic animals there occurs with considerable frequency a 
group of diseases characterized chiefly by a profound disturbance 
of the central nervous system, which express themselves either in 
tonic and clonic spasms or in coma. These diseases appear 
usually soon after parturition, but may occur during the act or 
shortly prior to that event. They all run a very rapid and 
stormy course, with a high mortality, except their course is in- 
terrupted by prompt and judicious treatment. 

The pathology of this group of diseases is unknown. Various 
theories have been propounded to account for the occurrence of 
these affections, but none of them have met with general accep- 
tance, and the correctness of none of them has been shown. Post- 
mortem examinations have revealed various lesions or alleged 
lesions, which may be regarded as results of, rather than the 
cause of, the malady. They fail to reveal the true character of 
the disease. For example, there is frequently found in parturi- 
ent paresis of the cow a well-marked pneumonia, which we 
know is not a part of the disease, but an inter-current com- 
plication due to the inhalation of food particles or medicines. 
Hemorrhages upon the brain have been found ; but this is not 
strange if an animal has thrown itself about violently for a 
number of hours, striking its horns with great force against 
the wall, floor or ground, and thus causing more or less injury 
by concussion of the brain. In a similar way we might account 
for other lesions which have been discovered upon post-mortem 
examination. In many instances the post-mortem revelations 
are 7nl, and it would appear from such knowledge as has been 
gained up to the present time that in reality no lesion has been 
discovered which constitutes an essential part of the malady, and 
consequently that its true pathology is unknown. 

The causes of this group of maladies in domestic animals are 
unknown. It is difficult to arrive at a general conclusion, be- 
cause various reasons are assigned, and there is no general agree- 
ment as to what maladies should be included in the group. 

In woman there occurs a somewhat common and highly fatal 
disease known as parturient eclampsia, which some authors con- 
sider identical with the parturient paresis of the cow, while others 
strongly dispute the identity or analogy of the two. 
911 



912 Veterinary Obstetrics 

The eclampsia of woman occurs most frequently, or in approxi- 
mately 50% of the cases, during birth. About 25% occur before 
parturition, and the other 25% after childbirth. The history of 
the date of attack of eclampsia in woman and of parturient paresis 
in the cow are somewhat alike in so far as the occurrence of cases 
before, during and after birth are concerned, but the percentages 
of cases during these various epochs are not at all alike. Very 
few attacks of parturient paresis occur in the cow during preg- 
nancy or labor, and almost all of them during the puerperal 
state. 

Eclampsia in woman is characterized by sudden and severe 
spasms, which endure for a few minutes, to be followed by a 
pause and later a recurrence of the spasms. The pause is some- 
times characterized by deep coma. The disease usually appears 
very suddenly, without warning, though in some cases there may 
be premonitory symptoms of unrest, headache and nervous twitch- 
ings. Then follows dilation of the pupil, with loss of conscious- 
ness accompanied by clonic and tonic spasms. The jaws are 
tightly closed, sometimes severely wounding the tongue. The 
temperature is usually high, and tends to become more elevated 
as the spasms are more severe. 

Upon post-mortem examination, the changes which are ob- 
served can scarcely be considered as characteristic of the disease, 
or as indicating the essential pathology of it. 

The symptoms of parturient paresis in the cow admittedly 
differ widely in a general way from those seen in the eclampsia 
of woman. This leads Harms to remark that a comparison of 
the symptoms of eclampsia in woman with this malady would 
cause anyone who had ever seen a case of milk fever in the cow 
to at once conclude that they were two wholly distinct maladies. 
Other veterinary obstetrists believe that the two maladies are 
essentially identical, in which opinion we concur. The two 
maladies appear at a similar date as related to parturition, the 
true pathology of neither has been satisfactorily determined, and 
post-mortem changes which can properly be considered as the 
basic lesions of the disease are wanting. 

In some domestic animals, especially in the mare, bitch and sow, 
it is not rare to observe a parturient eclampsia which, in history, 
symptoms, course and termination, is quite parallel to that ob- 
served in woman. There are present similar tonic and clonic 



Ptierperal EdampHe Diseases 913 

spasms, the well-marked trismus, the pirouetting of the eyes, 
the elevation of temperature, the stormy course and the high 
mortality. 

Though we usually observe profound coma instead of spasms 
in the parturient paresis of the cow, this does not prove the non- 
identity of it with the eclampsia of woman. Tonic and clonic 
spasms are common in woman, and in some of the domestic ani- 
mals, from a variety of causes. Coma in some animals, like the 
horse, is exceedingly rare. In the cow coma is a common symp- 
tom of disease, and occurs in many maladies. We see it in indi- 
gestion, especially from over-feeding, in which, in the horse, in 
man or in carnivora, we might see spasms. We observe coma 
in the cow as a result of infections from the uterus or udder, and 
along with these we may meet with a sub-normal temperature, 
just as we do in parturient parasis. Coma also appears at inter- 
vals in the eclampsia of woman, and tonic and clonic spasms ap- 
pear in the parturient paresis of the cow. The difference in 
symptoms is not basic, but rather a question of preponderance of 
spasms as related to coma, or vice versa, in the diiferent patients. 

In one instance we observed a cow in which the general symp- 
toms of eclampsia were present a few hours after easy parturi- 
tion. The pupils were dilated, the eyes were rolled, there was 
grinding of the teeth with frothing at the mouth, there were 
clonic spasms, especially of the head and neck, and a general 
disturbance of consciousness, so that the animal looked and acted 
as if temporarily insane. The condition lasted for about two 
hours, when the symptoms passed into those of ordinary parturient 
paresis, with the profound coma and sub-normal temperature. 

In other instances of parturient paresis we have observed some- 
what similar, though less marked eclamptic symptoms in the 
earlier stages, but these have quickly passed into the character- 
istic symptoms of paresis. 

While our knowledge of eclampsia in woman and in the do- 
mestic animals remains so imperfect as at present, with our 
equal want of knowledge as to the nature of the parturient pare- 
sis in the cow, it is impossible to determine precisely what rela- 
tion they bear to each other. It would appear from the fore- 
going that, until some positive knowledge as to the actual causes 
of these diseases is obtained, they should be considered as con- 
stituting one great group dependent upon the same general 
5« 



914 Veterinary Obstetrics 

causes. The disease is expressed somewhat differently by the 
various species of animals. Here and there a case occupies a 
middle ground between the symptoms recognized as character- 
istic of two different membefs of the group, constituting connec- 
ing links which serve to bind them more or less closely together 
into a highly interesting class of diseases. 

a. Parturient Eclampsia in the Mare. 

Parturient eclampsia in the mare is a disease which is closely 
related to the parturient state, and is expressed chiefly by violent 
tonic and clonic spasms, which run a very rapid course, and 
quickly terminate in recovery or death, without producing any 
lesions yet discovered which may be properly considered as 
fundamental. 

So far as we know, the first definite description of this disease 
was a paper presented by the author before the Illinois Veteri- 
nary Medical Association, which later appeared in the American 
Veterinary Review, Vol. [4, page 559. Since that time a few 
cases have been described which seem to be identical, and in 
various personal communications, practicing veterinarians have 
assured us of the occasional occurrence of this malady in their 
practice. Under the designation of trismus, Plaskett describes 
cases which appear identical with ours. (American Veterinary 
Review, Vol. 23, page 254.) 

There is a bare hint of eclampsia in the mare by Fleming 
(Veterinary Obstetrics, p. 660), who, in speaking of parturient 
apoplexy of the cow, says, " It is worthy of notice that the first 
stage of parturient fever, viz., the stage marked by congestion 
of the brain, is observed in the mare. It soon terminates in 
death, as is also sometimes the case with the cow, as a result of 
apoplexy. Such cases, though not sufficiently substantiated by 
the result of autopsies, have been described by Gerard (Veteri- 
narian, 1874). The mares in question died during parturition, 
or soon after." Gerard's cases were evidently essentially differ- 
ent from those here described as eclampsia. 

My first case occurred in an adult grade draft mare, which had 
at her side a healthy, vigorous foal, some ten days old. The 
mare had foaled naturally and easily at the ordinary time, and 
the very apparent vigor of the foal showed clearly that she had 
been furnishing an abundant supply of milk. The owner re- 



Parturient Eclampsia in the Mare 915 

ported that a few hours prior to my arrival the mare suddenly 
became strangely nervous, assuming a wild look, with staring 
eyes, restlessness, stiffness of gait, twitching of the muscles, 
occasionally lying down and getting up. The symptoms all very 
rapidly increased, until she lay prostrate on her side, unable 
to rise. In this position I found her, with the whole muscular 
system exceedingly rigid, breathing labored, convulsions con- 
stant, pupils greatly dilated, mucous membrane livid, firm tris- 
mus, and the muscles of her limbs so rigid that they could not 
be flexed sufficiently to raise her upon her chest. 

The second case was a high grade draf c mare, used exclusively 
for breeding purposes, and aged six years. The mare was quite 
large, very robust and had foaled ten days previously without 
difficulty. The foal at her side was very vigorous and well nour- 
ished. 

I found the mare lying apparently quiet on her sternum, show- 
ing no evidence of suffering and looking quite bright and healthy. 
Upon approaching her, however, she showed marked nervous- 
ness, and at once tried to get up, but appeared to have lost the 
power of co-ordination. Her efforts brought on clonic spasms of 
a severe character. Her hind legs knuckled at the pasterns, 
much as in azoturia. 

During my stay she became more nervous and uneasy, making 
repeated unsuccessful attempts to rise. Respiration was rapid 
and laborious, and there were constant and severe cramps of the 
entire body, tremblings and profuse perspiration, all of which 
appeared to decrease in intensity when we would withdraw and 
permit her to become more tranquil. The passage of the catheter 
increased the convulsions quite markedly. There was appar- 
ently hyperaesthesia of the vulva, and of the body generally. 

I diagnosed azoturia, and prognosticated a favorable termina- 
tion. Later observations have shown me that mares with young 
foals do not contract azoturia ; moreover, the fact that the mare 
had been running at grass constantly, precluded the possibility of 
that disease. She died a few hours later. 

During the summer of 1889 an unusual number of cases oc- 
curred in rapid succession, showing every degree of intensity. 
At this date our rapidly developing horse-breeding interests 
had about reached their maximum in my locality, so that large 
numbers of mares were kept solely for breeding purposes. Favor- 



9i6 Veterinary Obstetrics 

able weather during the season furnished exceedingly luxuriant 
pasturage. During that year I observed seven well marked cases, 
several of which offered favorable opportunities for observation 
throughout a greater part of the course of the disease. 

A well-bred road mare, in high condition, with a vigorous, 
well-nourished foal, eight to ten days old, at her side, was 
brought from the pasture preparatory to being bred. Soon after 
her arrival at the owner's stable, it was noticed that the mare 
was restless and nervous, her eyes somewhat staring, and occa- 
.sional muscular twitchings were present. Most noticeable of all 
was a peculiar, very well-marked throbbing of the chest, which 
shook the entire body. It seemed like an exaggerated heart- 
beat, and was quite regular in rhythm and force, but was not 
rhythmical with the heart-beat. The disturbance seemed great- 
est along the line of attachment of the diaphragm to the ribs, 
and the phenomena could be attributed to no other cause than 
clonic spasm of the diaphragm. There was some trismus present, 
but not sufficient to prevent the patient from eating with relish 
and comparative ease. 

With quietude and moderate doses of belladonna and cannabis 
Indica, she made a good recovery in a few hours. 

In another case I was called to attend a half-blood draft mare, 
aged seven years, in prime condition and perfect health prior to 
the date of my visit. She had foaled ten days before without 
trouble, and the foal was vigorous and well nourished. She was 
then brought from the pasture for the first time, and placed in 
the stable. Within a few hours, symptoms of disease were 
manifested. 

I found the animal in great pain, very nervous, and easily dis- 
turbed by any movements or noise. She lay down quite fre- 
quently. While Ij'ing, she became more tranquil, and all the 
symptoms abated. While down, the animal lay on her sternum, 
and did not attempt to roll ; in rising she did so with apparent 
ease. While standing there were constant clonic twitchings of 
the muscles of the entire body, spasmodic movements of the 
limbs, frequent changes in posture, trembling, profuse sweating, 
with the nostrils widely distended, and the movements stiff as in 
tetanus. There was no protrusion of the membrana nictatans 
over the eyeballs, but the eyes were staring, the pupils dilated, 
and the conjunctivae dark livid in color. There was severe tris- 



Parturient Eclampsia in the Mare 917 

mus, aud the jaws were wholly immovable. As in the pre- 
ceding case, there was violent spasm of the diaphragm. She 
was bled freely from the jugular, and given large and repeated 
doses of belladonna and cannabis Indica. For nearly thirty-six 
hours the sj-mptoms remained about the same, when they began 
to abate rapidly, and in 48 hours after the beginning of the 
attack the mare was in her usual health. 

On the same day, on a neighboring farm, I attended another 
grade draft mare with a similar history of recent eas}' parturi- 
tion, healthy foal at her .side, etc. Prior to my arrival, she had 
shown a similar train of symptoms to those noted above ; but 
the owner delayed calling me, so that upon my arrival I found 
the animal prostrate on her side, the whole muscular system 
thoroughly tetanized, the eyes set and insensible to light, firm 
trismus, well-marked opisthotomos, repeated severe convulsions 
of the entire body, readily increased by any sudden noise. 

Barring the want of protrusion of the membrana nictatans and 
the greater nervousness, the case closely simulated recumbent 
tetanus. The animal succumbed after about twenty-four hours. 

In another case I was called to attend a full-blood draft foal, 
five- or six days old, which was suffering from lameness. In 
order that the foal might be well attended, the mare was brought 
from the pasture and placed in the stable. The next morning I 
was hurriedly called to attend the mare, which I had seen the 
previous day in apparently perfect health and unusually robust 
and vigorous. Upon my arrival at the farm I found her greatly 
agitated, the whole body tetanized, with constant clonic twitch- 
ings, spasmodic movements of the limbs, hurried, labored respi- 
rations, nostrils widely dilated, visible mucous membranes of a 
dark livid hue, firm trismus and profuse sweating. When on 
her feet she could not stand still, but continually moved about 
involuntarily, and so very uncertainly that she could scarcely 
be approached with safety. The perspiration was so profuse 
that it streamed from the dependent parts of her body, the nose 
was poked out, the head elevated, the back arched, the tail 
erected, giving the entire body the posture assumed in severe 
tetanus ; but the well-marked protrusion of the membrana nicta- 
tans seen in the latter disease was wanting. The animal would 
lie down frequently, usually on the sternum, in which position 
she became more tranquil and apparently obtained some relief. 



gi8 Veterinary Obstetrics 

At other times she lay prostrate on her side, in severe convul- 
sions, the legs all rigid, so that the upper feet did not touch the 
ground, but projected in a straight line from the body. The 
spasm of the diaphragm was so violent that even when the mare 
was lying on her sternum her whole body shook violently at each 
diaphragmatic contraction. When the patient was standing fif- 
teen or twenty feet distant, a loud thumping noise could be heard, 
emanating from the chest, like violent palpitation of the heart ; 
but upon close examination it was found that the disturbance 
was not synchronous with the heart-beat. 

With great difficulty, owing to the uncertain convulsive move- 
ments of the animal, I drew about three gallons of blood from 
the jugular. This was followed by heavy and repeated doses of 
fluid extract of belladonna and cannabis Indica every hour. 

My prognosis was very unfavorable, as death seemed imminent. 
After twelve to fifteen hours the symptoms rapidly abated, and 
within twenty-four hours after my visit she was apparently in 
her usual health. 

In another case, a high-grade draft mare of vigorous constitu- 
tion, with a well-nourished healthy foal about fifteen days old at 
her side, was taken from the pasture for the first time since foal- 
ing and put to light farm work. In a few hours she had devel- 
oped all the symptoms enumerated in the preceding cases, and 
when I arrived she was unable to regain her feet. She rapidly 
grew worse, and died the same day, within twelve hours from the 
time she was brought from the pasture in prime condition, and 
only five to eight hours after the beginning of the attack. 

Another case was that of a little imported pony mare in high 
condition, with a well nourished foal at her side, six or eight 
weeks old. The pony was brought from the pasture for the 
first time since foaling, saddled, and placed in the hands of 
children, who used her for a few hours in the morning. At 
noon the stableman found some difficulty in removing the bit 
from her mouth. 

This attracted no particular attention, but when the owner at- 
tempted to bridle her again after dinner, and failed on account 
of firm trismus, it was evident that something serious was wrong. 
A veterinarian was at hand in a few hours, but the pony rapidly 
developed all the symptoms enumerated in the preceding cases. 
She was bled from one jugular on the first, and the other on the 



Parturient Eclampsia in the Mare 919 

second day. In about forty hours after the beginning of the at- 
tack, the symptoms suddenly abated, and within forty-eight 
hours the pony was apparently as well as ever. 

We have here a series of cases presenting symptoms no more 
varied than we would expect to find in different individuals in 
different stages of the development of the disease, yet passing 
from one into the other by imperceptible gradations, all apparently 
due to the same cause. 

In the earlier stages, and in the very mild cases throughout, 
all showed the restlessness, the staring, pirouetting eyes, the 
clonic spasms, especially marked in the diaphragm. In propor- 
tion to the nervousness, the pulse and temperature are little 
altered. If unchecked, the clonic spasms are largely succeeded 
by those of a more tonic nature, trismus becomes a marked 
symptom early in the maladj', the restlessness and convulsions 
increase in intensity, the respiration becomes more labored, the 
mucous membranes livid from partial asphj'xia, the whole muscu- 
lar system extremely tetanized. The animal finally becomes 
unable to stand, or to find relief in lying on the sternum, but lies 
prostrate on the side in constant convulsions until it succumbs 
from asphyxia. 

■ The history is quite uniform. The disease occurs wholly in 
vigorous mares, in high condition, of mature age, but not old. 
They have recently foaled naturally and easily, and have healthy, 
well nourished foals at their sides. The mammary glands are 
well developed and active in all cases. In nearly, if not all the 
cases I have related, the mares had been enjoying unrestricted 
freedom at pasture constantly since foaling, until taken up a few 
hours prior to the attack, which was suddenly ushered in without 
warning. 

It seems that a sudden change of surroundings, a change from 
freedom to the stable or harness, probably by causing maternal 
anxiety for the foal, has an essential influence in the immediate 
causation of the disease. The symptoms indicate a grave dis- 
turbance of the central nervous sj'steni, expressed for the most 
part in convulsions and spasms of the striated muscles. The 
symptoms we have enumerated as occurring in the mare bear a 
close resemblance to those of eclampsia of other lower animals 
and of woman, as well as to the early stages of parturient apo- 
plexy of the cow. 



920 Veteririary Obstetrics 

The disease in the mare is ushered in suddenly, runs a rapid 
course of twenty-four to forty-eight hours, and terminates as 
abruptly as it began, in complete recovery, or in death. 

The diagnosis should apparently be quite easy in all cases. 
The history of the case, so far as observed, seems of special value. 
The clonic and tonic spasms, the extreme trismus, and the 
peculiar spasms of the diaphragm, are quite characteristic. It 
may be confounded with : 

(a) Tetanus, from which it is distinguished by the sudden 
onset, the earlier and more complete trismus, the peculiar spasm 
of the diaphragm, the greater nervous irritability and greater 
tendency to clonic spasms, the greater tendency to lie down, the 
dilation of the pupil and pirouetting of the eyes, the absence of 
the protrusion of the membrana nictatans, the absence of any 
antecedent wound, the far more rapid course and the usually 
more favorable termination. 

(b) Cerebro-spinal meningitis, from which it is to be separated 
by its history, its more sudden onset, its cramp unaccompanied 
by paralysis, its well marked trismus, rapid course and more 
favorable termination. 

(c) Azoturia, from which it differs essentially in attacking 
animals not subject to that affection — that is, mares enjoying 
unrestrained liberty and having young foals. Aside from the 
fact that azoturia cannot be induced in such animals, the spasms 
are more general over the entire body, the trismus is character- 
istic, and the urine neither abundant nor highly colored. 

The treatment should evidently consist first of quietude and 
comfort. The foal should be allowed with the mare. In my 
cases, free blood-letting apparently alleviated the symptoms, if 
resorted to early. 

Fluid extracts of belladonna and cannabis Indica, in large and 
repeated doses, apparently allayed the excitability, and exerted 
a favorable influence upon the course of the disease. 

b. Parturient Paresis in the Cow. Milk Fever. 
Parturient Apoplexy. 
Parturient Paresis has long been known as an exceedingly 
common, and until recently highly fatal maladj' of dairy cows. 
It has apparently been known as long as dairying has been fol- 
lowed as a scientific pursuit, and cows have been bred especially 
for dairying purposes. 



ParUirient Paresis in the Cow 



921 



Somewhat rarely it may attack cows belonging to the dis- 
tinctively beef breeds, but even then it is usually in those which 
are heavy milkers. 

The disease occurs usually in adult cows, rarely in the young 
or aged. Harms, citing Bavarian statistics, gives the following 
table of the ages at which 127 cows were attacked by milk fever. 

At the age of 3 years i 

4 " 4 

5 " 20 

6 " 14 

7 " 22 

8 " 18 

9 " 22 



10 



Harms, quoting Haycock, gives the following duration of 
time after parturition, at which parturient paresis made its 
appearance. 

5 times immediatel}' after calving. 

8 " 20 hours " 

5 " 23 " 

5 " 24 " 

3 " 30 " 

2 " 36 " 

I " 42 " 

We have diagnosed parturient paresis, both before and during 
parturition. In these cases all the cardinal symptoms of the 
malady presented themselves, and the course and termination were 
identical with those usually observed. 

Harms, early in his career, diagnosed cases of milk fever before 
birth, during the act, and as long after parturition as 30 days ; 
but later he concluded that he had been in error and had been 
dealing with spinal meningitis or hydrocephalus, two diseases 
which he regarded as very difScult to differentiate from milk fever. 
According to his view, parturient paresis in the cow does not 
occur at all before the fetal membranes have been expelled. He 
cites other practitioners, however, among whom is Thomsen of 
Flemsbury, who had a cow fall with paresis while he was remov- 



92 2 Veterinary Obstetrics 

ing the afterbirth manually, and Kohler, who found the detached 
membranes in the uterus in cases of paresis. 

Other observers have seen cases in which the malady has 
occurred under other conditions. We were called to attend a 
cow because of presumed dystokia, and found her standing with 
portions of the membranes hanging from the vulva. Upon ex- 
amination it was found that the fetus was in its normal position 
and alive,' and that the cervix was fully dilated. All that ap- 
peared to be wanting was a moderate expulsive effort on the part 
of the cow, but this did not occur. She seemed well in a general 
way, except that she was unsteady upon her feet. The fetus 
was extracted under very moderate traction, without any aid 
from the mother. Some two hours later she fell, exhibiting all 
the symptoms of parturient paresis, and perished therefrom a 
few hours later. 

In another instance in our practice, a typical case of paresis 
occurred, where the animal was down and comatose, and the 
placenta was still feebly retained in the uterus. 

The disease is one of well-nourished animals. It does not 
occur in those cows which have been starved or have been kept 
upon food of very bad quality, and consequently are in poor 
condition. On the other hand, the excessively fat cow does 
not show so great a tendency to the disease as the one which 
is in good flesh. It is a disease belonging to the highly-nourished 
animal, and not to the obese or the emaciated. 

In all those cases of parturient paresis occurring subsequent 
to parturition, and virtually all of them occur during this period, 
the disease follows an easy birth. Along with this, in almost 
every case, there is prompt expulsion of the fetal membranes. 

Symptoms. When the animal is under close observation, 
preceding the full development of the symptoms of parturient 
paresis there is usually first noted a staring expression of the 
eye, with dilation of the pupil and a wild look. The eyes may 
be pirouetted or rolled in their orbits. There may be occasional 
muscular twitchings or contractions, and a condition of unrest. 
In rare cases there are very distinct clonic spasms, especially of 
the neck, with grinding of the teeth and slobbering. The ani- 
mal acts as if affected with mania, and executes various move- 
ments with the head. In one case we observed that the cow 
would bite at her shoulder. If the cow is cau.sed to move she 



Parturiejit Paresis in the Cow 923 

does so with a more or less unsteady gait. She seems especially 
weak and uncertain in her hind limbs, and sways somewhat from 
side to side or knuckles over. She may show considerable un- 
easiness and nervousness, aud lie down, only to get up again in 
a few minutes, and perhaps with some difficulty. 

As the disease progresses the animal goes down and is unable 
to rise. At first she lies upon her sternum, usually upon the 
left side, in a somewhat natural attitude, with the head up. 
Later she shows a tendency to rest the muzzle on the ground or 
the head in the right flatik with the nose lying upon the ground. 
Still later she tends to lie prone upon the side. 

Early in the disease coma sets in, and the animal becomes 
more or less insensible. Convulsive struggles occur for a time, 
in which the patient throws herself about violently ; she may 
make unsuccessful and unconscious efforts to arise, and may suc- 
ceed in getting upon her knees and floundering about violently. 
She may throw the head from side to side with great violence, 
and in doing so may shift from sternal to lateral recumbency, 
and from time to time may resume sternal decubitis. As the 
disease advances, there is a constantly increasing tendency to lie 
flat upon the side. 

At first the pupils are dilated and the eyes have a wild and 
glaring look, but later they become dry and glassy-looking, 
probably because the eyelids are not closed frequently in order 
to distribute the tears over the cornea, and thus fail to keep it 
moist. An abundance of tears may flow down over the cheeks 
and keep them wet. 

From the mouth there is an involuntary flow of saliva, due 
rather to failure of the animal to swallow it than to any increase 
in the amount secreted. 

The temperature is sub-normal. Rarely in the earlier stages 
of the disease, accompanied by more or less violent muscular 
twitchings, there may be elevation of temperature. lyater, when 
the disease has existed for some hours and there has been partial 
improvement, and a relapse occurs, not of paresis, but of inhala- 
tion pneumonia or other inflammatory complication, the tempera- 
ture may become elevated. The respiration is deep and slow as 
a general rule, though in some cases it may be rapid and shallow. 
There is sometimes a moan during expiration. 

The disturbances in the alimentary tract consist essentially of 



924 Veterinary Obstetrics 

a profound paralysis. There is difficulty in deglutition, so 
that in former times many cows were killed in attempting to 
drench them with fluids, which, instead of being swallowed, 
passed into the lungs, causing fatal strangling or bringing about 
an equally fatal foreign-body pneumonia. The rumen is para- 
lyzed, and as a consequence tends to become filled with gas owing 
to decomposition of its contents. This is especially marked if 
the animal lies upon her side. This symptom is one of great 
danger for the animal, because the tympany tends to press the 
food up through the oesophagus into the pharynx, whence it 
drops into the larynx and is inhaled, to either cause fatal 
strangliug or later a fatal foreign-body pneumonia. The in- 
testines are likewise paralyzed, and little or no defecation occurs. 
If the hand is introduced into the rectum, a small amount of dry 
feces is found. 

The kidneys cease to function, and little or no urine is poured 
into the bladder. Some veterinarians have urged that it is 
essential in the treatment of the disease for the catheter to be 
frequently passed in order to prevent rupture of the bladder. 
As a matter of fact, unless the bladder is distended when the 
disease comes on it does not become so until after the malady 
has ceased. 

The secretion of milk is wholly in abeyance. There may be a 
small amount of milk in the udder at the time that the cow goes 
down, and this may remain for a time, but there appears to be 
some tendency for it to become resorbed and the udder very 
flaccid. 

The pulse at first may be slow and weak, becorning later more 
frequent and irregular. 

The general sensation is much depressed. Earlj' in the disease 
the eye seems somewhat sensitive to light or touch, but later the 
cornea may be touched without causing any reaction, and the 
skin may be pricked at any point with a pin or other sharp ob- 
ject, without producing any evidence of feeling. 

As the disease progresses, the coma and paral3'sis become more 
and more profound, and death may occur at any time without 
warning, or the coma may gradually deepen and the animal ap- 
pear almost lifeless for hours before death occurs. As the fatal 
termination approaches, the coma and paralysis become more and 
more profound, the breathing more shallow, and the pulse weaker 
and more irregular, while the temperature continues to sink. 



Parturient Paresis in the Cow 925 

The course of the disease is rapid. Generally, the earlier the 
advent of the malady after parturition, the more rapid its course. 
The animal may die within 6 or 8 hours from the beginning of 
the attack, or the disease may be prolonged to two or three days. 

Complications of great variety may occur. In some especially 
stormy cases there is complete prolapse of the uterus as one of 
the earliest symptoms, and in these death usually ensues very 
quickly. In two cases in our experience, the animals perished 
within two or three hours after the advent of the first symptoms 
of the disease. 

One of the most common and serious complications observed 
in the course of the disease is that of foreign-body pneumonia, 
or of strangling owing to the inhalation of solids or liquids. A 
few years ago it was common to drench a cow with large vol- 
umes of oil or of solutions of saline cathartics or other medicines, 
which in many cases flowed directly into the lungs because of 
the unconsciousness of the animal and the paralysis of the 
pharynx. In other instances in the comatose animal, there is 
an involuntary passage of food from the rumen through the 
cesophagus into the pharynx, from which it is inhaled into the 
the lungs. In either case the animal may be quickly strangled 
by the blocking of the bronchial tubes from the food or medi- 
cines. It was formerly a common experience for the veteri- 
narian to give a large dose of medicine and have the animal 
perish before he could get off the premises. 

When immediate death from the inhalation of food or drugs 
does not ensue, the paralysis and coma may continue, and the 
symptoms of parturient paresis pass imperceptibly into those of 
pneumonia. In other cases the animal partially recovers, and 
seems brighter, and may even recover so far as to regain her feet 
and possibly take some food. After some hours, or even a day 
or more, she may show signs of pneumonia with elevation of 
temperature, and go dowti again to finally perish from the 
complication. 

Diagnosis. The diagnosis is usually rendered clear by the 
period of the occurrence of the disease, the condition and char- 
acter of the animal, and the symptoms. In some cases, how- 
ever, the differential diagnosis may be exceedingly difficult, 
and afford abundant room for a conflict of opinion between 
practitioners. 



g26 Veterinary Obstetrics 

Harms very properly points out that the peculiar attitude of 
the cow does not always indicate parturient paresis, but that 
other diseases, like acute hydrocephalus, spinal myelitis and 
meningitis, may cause the animal' to assume the same position. 
Harms considers these the only diseases which may be mistaken 
for parturient paresis, and suggests that puerperal mania, puer- 
peral fever, simple lumbar paralysis and fracture of the pelvis 
cannot deceive the scientific veterinarian. Harms points out 
that in his experience the diagnosis of milk fever may be ex- 
cluded in those cows which have not calved recently, which show 
loss of sensation in the hind parts of the body only, or have a 
normal or elevated rectal temperature. Cows which retain an 
appetite until they fall, or even after they are down and unable 
to ri.se, he does not regard as being affected with parturient paresis. 
On the other hand, he claims that hydrocephalus may be ex- 
cluded and milk fever diagnosed if the cow has calved within a 
few days, if the loss of sensation involves the entire body, if the 
rectal temperature is sub-normal, and the paralysis is so profound 
that the animal cannot rise upon its feet even with assistance. 

The relation of calving to the diagnosis of parturient paresis, 
in our judgment, cannot be relied upon, although it constitutes 
important evidence. While Harms believes that the disease 
occurs only after parturition, and we agree with him in the 
main, we are nevertheless forced to hold, from our personal 
observation, that the malady is not confined to the post-parturi- 
ent period, but may rarely occur before or during the act of 
parturition. The fact that a cow has recently calved does not 
prevent the occurrence, during this period, of other diseases 
which may closely simulate parturient paresis. 

Schmidt (American Vet. Review, Vol. 22, 1898) draws atten- 
tion to the fact that indigestion in the cow may very closely 
simulate parturient paresis. 

In one case which we observed, a cow went down in the past- 
ure with what strongly resembled parturient paresis in almost 
all essential respects, including paralysis, coma, and subnormal 
temperature, but she had calved six weeks previously. The 
disease was apparently due to a slight purulent mammitis. It 
is interesting to note, in connection with this case, that the in- 
jection of oxygen into the udder apparently led to a complete 



Parturie7it Paresis hi the Cow 927 

recovery. This would lead manj' to believe that the malady 
was really parturient paresis. 

Causes. While we do not comprehend the fundamental 
nature of milk fever in the cow, we nevertheless know fairly 
well the conditions which predispose or lead up to the disease. 

1. Chief among the causes, stands the quality of the cow as a 
deep or profuse milker. Milk fever is pre-eminently a disease of 
the high-class dairy cow, and has herertofore stood as a perpetual 
menace against the improving of dairy breeds, because the more 
excellent the individual as a dairy animal the more vulnerable 
to the disease. On the other hand, cows belonging to the beef 
breeds, or poor, milkers among dairy cows, are virtually immune. 

2. The state of nutrition of the animal has a very marked and 
well known influence upon the occurrence of parturient paresis. 
This is a disease of the plethoric cow, and not of those which 
are emaciated or excessively fat. It occurs, we may say, in 
those animals which are in the highest possible condition, and 
apparently in perfect health up to the hour of attack. 

3. Food and housing have been claimed to influence the tend- 
ency of the cow to parturient paresis, and this is in many re- 
spects very true. The maladj' is seen much more frequently in 
some seasons and in some communities than in others, which is 
variously attributed to the food or weather. These questions 
are inseparable from that of nutrition. If the weather is bad, 
the food may be bad. Undue exposure may lower the condition 
of the animal, and thus prevent the high condition which predis- 
poses to milk fever. 

We observe the disease in the stable and in the pasture, and 
the relative frequency will vary according to conditions. Par- 
turient paresis may occur chiefly during the spring or early 
summer, in cows which are upon very rich pastures ; or in other 
cases the disease may be seen most frequently in those animals 
which are kept in the stable. This will vary according to the 
comparative excellenc}^ of the pastures or of the food and feeding 
in the stable. 

4. Abrupt changes in food, housing or other conditions may 
apparentl}- influence the tendency to the disease. In the other 
members of this group of diseases we recognize ver}' clearly the 
effect of psychic influences, such as removing the young from 
the mother or bringing the mother and her young into the pres- 



928 Veterinary Obstetrics 

ence of strange animals or surroundings, thereby causing ma- 
ternal anxiety. This apparently has an effect in some cases in 
the cause of parturient paresis of the cow. 

5. It is quite universally recognized that, when parturient 
paresis occurs soon after calving, at which epoch virtually all 
cases occur, the malady uniformly follows a very prompt and 
easy birth. No case has been recorded, so far as we can find, 
where parturient paresis in the cow has followed dystokia. 

Pathology. As already stated, the pathology of the dis- 
ease is unknown. Post-mortem examination reveals changes 
of an interesting character, which tend to throw some light upon 
the symptoms and course of the disease, without, however, 
making clear its exact character. 

Because of the well-marked coma and the general disturbance 
of the nervous system, the condition of the brain and the spinal 
cord become of great interest. The dura mater is apparently 
sound, though in some cases a serous exudate exists beneath it. 
The pia mater is said to be somewhat congested ; the veins, es- 
pecially, are distended with blood. The interpretation of the 
conditions in the brain varies with different observers. Some 
have found the brain substance anaemic, while others have con- 
sidered it congested. Hemorrhages are sometimes found upon 
the surface of the brain. Harms found emphysema beneath the 
pia mater and in the veins of the canal of the spinal cord. 

The heart is usually pale and distended with blood, and occa- 
sionally shows ecchymoses of varying size. 

The condition of the lungs is exceedingly variable. Harms 
found them edematous or emphysematous, but observed no 
foreign bodies in them. We have repeatedly discovered particles 
of food far down in the bronchial tubes, and in some cases of 
sudden death have found the larger bronchi completely occluded 
by food masses. In other instances we have been able to rec- 
ognize the presence of drugs in the bronchial tubes, which had 
been forced upon the cow in the form of a drench some hours 
previously. 

The alimentary tract, liver, spleen and urinary organs are 
usually comparatively normal. In the uterus there are no very 
remarkable changes. In harmony with the history of the disease, 
the uterus is not normally contracted. Like other organs of the 
body, the uterus is anaemic. 



Parturient Paresis hi the Cow 929 

The theories regarding the nature of parturient paresis are in- 
numerable, and difficult of classification. These may be divided 
into four great classes, according to the belief veterinarians hold 
as to the organ or system from which the disease takes its 
origin. 

1. Many hold that the disease has its origin in some essential 
change in the brain or spinal cord. They believe the disease to 
consist of a congestion of the entire central nervous system, with 
overfilling of the veins of the brain and spinal cord. Other veter- 
inarians hold that the disease consists of anaemia and paralysis of 
the central nervous system. 

2. Another group of veterinarians believes that the disease 
has its essential origin in the uterus. In this group each indi- 
vidual has an opinion of his own, which differs somewhat from 
that of each of his colleagues. Some of them believe that, from 
the uterine mucosa, there is absorbed into the system an amount 
of infectious material or the products of bacterial activity within 
the uterine cavity, which, acting upon the central nervous .sys- 
tem, produce the disease. The character of this toxic substance 
has not been revealed, nor has any clear evidence been adduced 
to show that such exists. It has not been shown why, if the 
disease consists of the absorption of toxic substances from the 
uterus, cows which are very thin in flesh, are poor milkers or 
have suffered from dystokia should not just as readily suffer 
from milk fever as deep milkers which are in high condition 
and have calved easily. Others, like Stockfleth, hold that milk 
fever is the result of embolism of the veins of the uterus, the 
emboli escaping to other portions of the body. 

3. A third group of veterinarians, including Schmidt of Kol- 
ding, holds that the disease arises from the mammary gland, and 
consists of a toxaemia due to the absorption of colostrum, per- 
haps incompletely formed, or other secretions which possess a 
highly deleterious character. 

4. Harms holds that the disease is a form of aeraemia, or air 
in the blood. In his post-mortem examinations he found air in 
the veins of the brain, spinal cord, lungs and other organs. 
This view has not been generally accepted. 

As already stated, post-mortem examination has virtually 
failed to reveal anything definite regarding the actual cause or 
character of the malady. This and that lesion has been re- 
59 



930 Veteriyiary Obstetrics ' 

corded, only to have its existence or importance disputed by 
others of equal authority. One finds hyperaemia of -the brain, 
and another anaemia of the brain, with the possibility that 
either or both may be correct.* 

Handling, i. The essential therapeutics of parturient 
paresis consists of the inflation of the udder ^with atmos- 
pheric air or oxygen. So far as clinical experience reveals, it 
is not material which of these is used. As soon as the patient 
can be reached, and a definite diagnosis of parturient paresis 
made, a sufficient volume of oxygen or atmospheric air should 
be introduced into each quarter of the udder to quite thoroughly 
distend all parts of the gland. In order to 'avoid the escape of 
the air through the teat canal, it may sometimes be desirable to 
apply temporarily a soft ligature near the end of the teat, which 
is to be removed after the expiration of three or four hours. 

The ligature should preferably consist of a soft piece of tape, 
which should be tied around the teat sufficientl)' tight to barely 
prevent the injected air from escaping through the teat orifice. 
If tied too tight, and allowed to remain for several hours, necrosis 
of the teat follows. The ligature is to be closely watched, and 
promptly removed whenever serious injury to the teat is threat- 
ened. The danger might be very largely avoided if a long piece 
of tape were used, and wound several times about the teat, from 
the apex upwards. Strips of adhesive plaster, applied directly 
over the teat orifices and extended upward along the teat, would 
probably fill all requirements and obviate pressure gangrene. 

The necessity for ligating the teat is very questionable. The 
amount of gas injected is subject to no fixed rule. The udder 
should be firmly distended. Usually the sphincters of the teats 
will retain sufficient gas and permit &\\y excess to escape. 
Some believe that the greater the distension of the udder with 
air, the more prompt and effective the treatment. Occasionallj^ 
this is overdone, and we have observed extensive emphysema of 
the udder, thighs and croup from rupture of the mammary epith- 
elium as a result of over-distension. No harm ensued. If the 



*For a full resume and discussion of the various theories of the nature of 
parturient paresis, the reader is referred to the contribution of J. Schmidt, 
Kolding, Monatshefte fiir Praktische Thierheilkuude. Bd. IX., S. 241, a 
translation of which appears in the Am. Vet. Review, Vol. 22, p. 392, Sept., 



Parturient Paresis in the Cow 931 

volume seems insufficient, if the response is tardy or feeble, 
more air or oxygen may be introduced at any time. 

Should the first inflation fail to produce the desired results 
after au interval of 3 to 6 hours, a second inflation of the gland 
should be made. We have no evidence that any harm may occur 
from repeated inflations of the udder with air or oxygen, so long 
as no infection is carried into the gland. 

Since the mammse are at this stage in a very highly vunerable 
state, it is essential to safety that due precautions be taken 
against introducing infection into the gland upon the portion of 
the apparatus inserted into the teat, or forcing it into the gland 
with the oxygen or air which is being introduced. 

The precautions to be taken are analogous to those for any 
surgical operation. They include the disinfection of the operator' s 
hands ; of the cow's udder, especially the teats ; aud of the injec- 
tion apparatus, especially the tube which is to be introduced 
into the teats ; and the protection of each of these parts from 
infection during the operation. 

The udder should be carefully placed upon a clean cloth sat- 
urated with a reliable disinfectant, or upon a clean tray, after 
which the entire gland, and especially the teats, is to be 
thoroughly washed and disinfected. The apparatus to be used 
for injecting the air or oxygen, especially the tube to be inserted 
into the teat, should be sterilized by boiling. 

Before inserting the tube into the teat, all antiseptics should 
be carefuUj'' washed away from the tube and the end of the teat 
with sterile water. The introduction of antiseptics into the 
milk gland upon a tube or other instrument is as dangerous 
as the introduction of most forms of bacteria. The opera- 
tion is to be aseptic, not antiseptic 

The mechanism by which the inflation is brought about is not 
essential, so long as the general rules of asepsis are maintained. 
Various forms of apparatus have been introduced for the purpose 
of avoiding infection, but few, if any .of them are free from ob- 
jection. No difference what the particular type of apparatus, the 
general rules of aseptic surgery must be carefully applied by the 
veterinarian ; the apparatus is not sufficient in itself. Many of 
these devices consist of a rubber bulb, attached to an elongated 
tube, into which is inserted a filter of asbestos, cotton or other 
substance. Beyond this, the rubber tubing ends with an ordinary 



932 Veterinary Obstetrics 

milk or teat tube, which is inserted into the milk canal. This 
form of apparatus is probably the most objectionable of any 
that has been devised, because the filter is difficult of steriliza- 
tion and, becoming befouled, acts as a constant menace to the 
udder of the patient. 

The simplest apparatus, the one which can be most readily 
sterilized by boiling, is the best. There is no great danger of 
the introduction of infection with the air which is introduced, if 
moderate care is taken not to stir up dust in the stall while the 
operation is in progress, and this danger may be eliminated in a 
variety of ways which are very simple. If a wash-bottle is con- 
structed, and the air be forced through the water, and thence 
into the udder, any floating particles of dirt will be retained in 
the water, leaving the air free from infection. 

Laymen have used the ordinary bicycle pump for injecting air 
into the udder, and the process has been bitterly criticised by 
some veterinarians. Such a pump, or one on a similar plan, with 
very ordinary precautions, is safer than the apparatus usually 
sold for the purpose. A pump of this type, with sterilizable 
piston, can be made a very convenient and safe appliance. It 
may be enclosed in a sterilizable metal case, and kept sterilized 
ready for use. At time of use, a few layers of sterile gauze over 
the intake effectively filter the air. 

A very convenient and safe apparatus for the work is the 
oxygen, or compressed air tank. Under proper precautions, the 
tank may be charged by the practitioner with either air or oxygen, 
and is ready for safe use at any moment. The tube for insertion 
into the teat may be carried in alcohol, so that it, too, is ready 
in a moment. 

A yet more convenient and safer apparatus for the inflation of 
the udder may be readily arranged by having a very small and 
strong compressed air tank, fitted with an opening armed with a 
stop cock. It could be made of the size of a pint bottle, and 
strong enough to contain sufficient air for the inflation of an 
udder. Two or more such tanks could be kept on hand so that 
one may always be charged and ready for use. The detached 
tube may be enclosed in a sterilizable metal container and quickly 
prepared for use. 

The tank may be charged by the veterinarian, the air being 
filtered through sterile gauze as it enters the pump. Thus 



Parturient Paresis in the Cow 933 

charged, under suitable precautions, the apparatus is always 
ready, compact, light, easily applied, and free from danger of 
causing infection. 

The milk tube or other tube inserted into the teat should be 
very short, barely long enough to freely enter the milk cistern. 
A longer tube may wound the parts during unexpected struggles. 

It is apparently immaterial whether any milk which may be 
in the udder is withdrawn before the injection or not. 

Some practitioners advise treatment supplementary to the in- 
flation of the udder, but they have not yet clearly shown by 
clinical data that any good has come from such additions. Gen- 
erally those who desire to add something to the udder inflation 
prescribe powerful heart stimulants, like strychnine or caffein. 

As a remnant of by-gone days, some veterinarians still advise 
and practice catheterization. The secretion of urine ceases with 
the advent of the disease. Over-distension could not have existed 
in the healthy cow, and cannot occur in the paresis patient. A 
pint or a gallon of urine in the bladder can do no harm ; 
catheterization may do much. 

The attitude of the patient is of very great importance. From 
the first she should be carefully and zealously guarded against 
assuming lateral recumbency, or this position promptly cor- 
rected if already attained. The cow, like other ruminants, 
promptly suifers from tympany of the rumen whenever lateral 
recumbency is maintained for a prolonged period. The disten- 
sion of the rumen, by its pressure upon the diaphragm, interferes 
seriously with respiration and with the action of the heart and 
other organs. The most serious danger from this position is 
that, in the paretic state of the animal, there is imminent risk of 
the involuntary passage of food from the rumen into the pharynx, 
and its inhalation into the lungs, to cause fatal strangling, or 
foreign-body pneumonia. It is consequently essential to keep 
the animal in sternal recumbency. This may be facilitated by 
packing bundles of straw about the animal. In cases of violence 
it may be desirable to secure the two anterior feet in such a way 
that the limbs cannot be extended. This is best accomplished 
by attaching a short strap or cord to each anterior foot, carry- 
ing these upward over the withers, and tying them together in 
such a manner as to keep the anterior feet completely flexed upon 
Ihe carpus. 



934 Veterinary Obstetrics 

It is quite unnecessary, to suggest that the animal be well 
bedded and otherwise made comfortable. 

The practitioner should be on his guard against the dangers 
of moving the recumbent animal from place to place. If the 
patient has fallen in a bad situation, out of doors or elsewhere, 
it may appear desirable that she should be conveyed to a stable 
or other suitable place for handling. In bringing about this 
transfer it is well-nigh unavoidable that she be placed in lateral 
recumbency, and that she must undergo a form of handling which 
will strongl}' tend to cause the regurgitation and inhalation of 
some of the contents of the rumen. 

It is therefore best, in all cases, to make the patient comfort- 
able, if possible, where she falls. Abundant bedding, blankets 
if the weather is cold, or an improvised tent or shed if the weather 
is hot or rainy, usually suffices as well as a stable and avoids the 
danger of transfer. When moving the recumbent animal is im- 
perative, she should be kept on her chest until all is in readi- 
ness, the transfer then made promptly, and the patient quickly 
replaced upon her sternum. 

When the practitioner is called to attend a case of parturient 
paresis, he should rigidly abstain from drenching the patient, 
and carefully enquire, before he takes charge, if any drugs or 
medicines have been given by the mouth. If cows suffering 
from parturient paresis have been drenched, the mortality is 
exceedingly high, because portions of the drench usually pass 
down the trachea into the lungs. It does not matter at what 
stage of the disease the attempt to drench the animal occurs. 
While she is still upon her feet, and merely beginning to stagger, 
she is nevertheless very liable to become strangled. There appears 
to be from the first an anaesthesia or paresis of the larynx and 
other parts, which prevents coughing or any other signs of 
strangling. If the animal has received a drench, especiall}' one 
which would be highly irritant to the lungs or could not be ab- 
sorbed from the respiratory mucous membrane, an unfavorable 
prognosis should at once be given; and the handling begun with 
a definite understanding that the animal will probably die from 
inhalation pneumonia as a result of the drench. 

***** 

The history of the origin of the present plan for handling 
parturient paresis dates back to the investigations of Schmidt of 



Parturient Paresis in the Cow 935 

Denmark, in 1897, when he introduced his plan of handhng the 
disease by the introduction into the udder of a solution of iodide 
of potassium, commingled with atmospheric air. L,ater, various 
practitioners found that, failing to have the potassium iodide at 
hand, the distension of the udder by other liquids, such as very 
weak disinfecting solutions or normal salt solution, possessed a 
similar efficiency. Then oxygen was substituted for the potas- 
sium iodide solution, and its efficiency was found to be even 
greater. From this experience it was readily surmised that, in 
default of pure oxygen, the mixture of oxygen and nitrogen of 
atmospheric air might answer the purpose, and clinical experience 
early demonstrated this to be a fact. Today oxygen and atmos- 
pheric air are used indifferently, and with very great success. 

The discovery of Schmidt, with its gradual development, 
leading to the now universally accepted mode of handling 
parturient paresis, constitutes one of the most remarkable 
and beneficent advances in therapeutics in the history of 
veterinary medicine. It has transformed one of the most 
fatal of diseases into one which, when promptly handled, 
is almost robbed of its mortality. 

Prior to the investigations of Schmidt, parturient paresis 
was a great obstacle to the advancement of efficiency in 
dairy cows. As soon as a cow showed high efficiency, 
imminent danger to her life from parturient paresis at 
once arose, and the ranks of the best dairy cows annually 
suffered appalling losses. 

Under the treatment with air or oxygen, the mortality in 
parturient paresis in the cow has dropped from 60-75% to 
less than 5 % , in tho.se cases which are promptly attended and in 
which there has been no meddling by the administration of 
medicines by the mouth. 

From the standpoint of prophylaxis, the attitude of the pro- 
fession has been quite generally modified by the advent of the 
present method of handling. Formerly it was advised in many 
cases to withdraw a portion of the milk from the udder before 
the cow calved, and to keep her well milked immediately after 
calving, but this rule has been reversed, and it is now advised to 
leave the udder fully distended with colostrum or milk. 

It was formerly advised, also, that a purgative be given either 
just before or immediately succeeding parturition, in order to 



936 Veterinary Obstetrics 

prevent parturient paresis ; but this has been generally discarded 
since the advent of the inflation treatment. 

It is now uniformly advised, in case there appears to be 
any danger of an attack of parturient paresis, that the 
udder be inflated at once with oxygen or air as a prophy- 
lactic measure. 

The history of the therapeutics of parturient paresis is exten- 
sive and interesting. Almost every form and character of treat- 
ment possible has been advised , and favorable reports of the use 
of each have been made. Purgatives long held a very high place, 
in spite of the fact that they were generally poured into the 
lungs instead of the rumen, and quite generally hastened the 
fatal termination. Stimulants, narcotics, sedatives, in endless 
profusion, were recommended by one, only to be condemned by 
others and finally to be discarded. 

Blood-letting was advised and abandoned. Hypodermic in- 
jections of strychnine, eserine, pilocarpine and many drugs 
were advised, with the great advantage that they did not get 
into the lungs and strangle the animal, but the results from their 
use were not satisfactory. External applications were used, such 
as stimulating liniments to the spine, and ice to the head. Intra- 
uterine injections of solutions of alum or other substances were 
advised. In spite of all these innumerable methods which were 
recommended by this or that practitioner, the high mortality of 
the disease still held its sway. 

Puerperal Eclampsia in the Sow. 

Hegel (Repertorium, Vol. 46,) de Bruin (Geburtshilfe bei 
den Kleineren Haustieren) and others, describe puerperal eclamp- 
sia in the sow. The malady is characterized, according to Hegel, 
by spasmodic movements of the neck, grinding of the teeth, con- 
vulsive movements of the facial muscles, inability to stand and 
elevation of temperature. 

De Bruin has usually observed the disease two to five days 
after farrowing and expulsion of the fetal membranes. Usually 
the birth has been easy. The symptoms are chiefly a more or 
less complete suspension of lactation, with paresis, coma, and in- 
testinal torpidity. 

The prognosis is good, and most cases tend to spontaneous re- 
covery after a few days. 



The Milk Disease of the Sheep 937 

Hegel advises bleeding from the tail, cold poultices to head 
and back, purgatives, tobacco clysters, etc., and, if trismus per- 
sists, the application of chloroform and oil to the masseter region. 

De Bruin warns the practitioner against drenches, always 
dangerous for swine because of strangling. He advises the use 
of electuaries composed of 10 grammes sulphate of magnesia, 50 
grammes powd. anise seed, and common syrup sufficient to make 
a paste. This is placed upon the tongue with a wooden spatula, 
and the entire quantity used during one day. He further advises 
applying tincture of camphor over the body to arouse the skin 
secretions. 

The Milk Disease of Sheep. Parturient Paresis 
IN Sheep and Goats. 

De Bruin describes a malady of ewes, closely resembling the 
parturient paresis of the cow, under the designation of milk dis- 
ease. It occurs chiefly in ewes from which the sucking lambs 
have been removed after having lambed normally some six weeks 
previously. The disease appears usually 2-24 hours after the 
removal of the lambs from the ewes. 

The sj'mptoms consist of absence of appetite, rumination or 
other digestive functions. The ewe ceases to bleat or hunt for 
her lamb, becomes paretic, with glassy eyes, loss of corneal reflex, 
coma, and the general symptoms of parturient paresis of cows. 

The prognosis is good, and the method of handling it is the 
same as for parturient paresis in the cow. 

De Bruin describes, under a separate heading, a parturient 
eclampsia of sheep, goats and swine, regarding this malady as 
esseutiallj' different in etiology or pathology from the milk dis- 
ease described above. 

The real ground for differentiation is not clear. In these cases 
the animals show definite tonic and clonic spasms. The disease is 
usually acute and stormy. It appears ordinarily soon after birth, 
though it may occur ante-partum. There is present trismus, 
opisthotonos, and general convulsions, with pirouetting of the 
eyes, followed by coma. 

Chloral hydrate in enemas, and hypodermic injections of mor- 
phine, are recommended for handling, and good results are re- 
ported. De Bruin does not mention inflation of the mammae with 
air or oxygen ; nor does he intimate why this should not be quite 



938 Veterinary Obstetrics 

as successful in the eclampsia of the sheep and goat as in the 
paresis of the cow. 

Puerperal Eclampsia of the Bitch. 

Next to the cow, probably the bitch suffers most frequently 
from puerperal eclampsia or paresis. The malady has rarely been 
observed prior to, or immediately following parturition. Usually 
it occurs from 2 to 8 days after giving birth to young. Occa- 
sionally it occurs 10 to 14 days after parturition, and rarely as 
late as 30 days. Ordinarily it follows easy parturition. It is 
most frequently observed in highly bred nervous animals, and 
occasionally follows the psychic disturbance incident to removal 
of the puppies from the patient. 

The symptoms are analogous to the eclampsia already de- 
scribed in the mare, ewe, goat and sow. The first symptoms are 
those of anxiety, restlessness and uncertain gait. The patient 
falls in convulsions, the voluntary muscles being affected with 
severe tonic and clonic spasms. As in other eclamptic diseases, 
the body excretions are largely in abeyance, the bowels are 
torpid, the urinary secretions are suspended, and the mammae 
are flaccid and devoid of milk. 

During the convitlsions, the patient remains conscious. lyater 
the convulsions may be followed by coma and unconsciousness. 
During the convulsions, the visible mucosa are cyanotic. The 
affection greatly resembles strychnine poisoning, but De Bruin 
points out the important difference that in strychnine poisoning 
the patient is easily excited, while in eclampsia no hypersensi- 
tiveness is apparent. 

The course of the Disease, like in other members of the 
eclamptic group, is usually stormy, and, unless energetically 
handled, ends fatally in 24 to 48 hours. The prognosis is 
good when the disease is promptly handled. 

De Bruin strongly recommends 20-40 mg. (0.3-0.6 grains) of 
morphia hydrochlor, hypodermically, repeated in a few hours if 
necessary. Others advise chloroform inhalations or chloral hy- 
drate enemas. Some have recommended the administration of 
ether or chloroform syrup by the mouth ; but, as in all diseases of 
this group, the powers of deglutition are uncertain, and there is 
constant danger from the introduction of medicines into the 
lungs. 



DISEASES OF THE MAMMARY GLANDS. 

In mammalia, the mammarj' glands constitute an essential 
part of the reproductive system, because it is through these that 
the new-born is enabled to live for a time after its birth, before 
it acquires the experience and power necessary to provide its own 
food. The mammae ordinarily come into function at the time 
when young are born. As soon as the young animals have 
acquired sufficient age and strength to lead an independent ex- 
istence, the glands cease to secrete milk, until their function is 
aroused anew at the next period of birth. 

Following the general rule of vulnerability of organs, the 
mammse are most subject to di.sease and accident during their 
period of activity, and rarely suffer during their interval of rest. 
The diseases of the milk glands may, accordingly, very properly 
be dealt with as a part of obstetrics, because they not only jeop- 
ardize the life and well-being of the mother chiefly during the 
puerperal state, but also have great importance for the life of the 
young at the beginning of its extra-uterine existence. 

Anatomically the milk glands of animals belong to the acinous 
type. The glands consist of numerous acini or glandular vesi- 
cles, lined with cuboidal epithelium. From each of these cells 
there emanate small milk canals, which finally unite with each 
other into common canals of larger size. These may empty into 
a large cistern and thence through a common opening at the end 
of the teat, Fig. 5A, p. 37, or two or more cisterns form, each of 
which opens through a separate milk duct, or the milk canals 
may remain separate, without milk cisterns and open directly at 
the end of the nipple. There are consequently two great t3'pes of 
milk glands — the one with a cistern, in which a considerable 
volume of milk accumulates ; and the other without a cistern, 
in which the milk canals lead from the glandular substance di- 
rectly to the end of the teat. 

Solipeds, ruminants and swine have capacious milk cisterns ; 
in carnivora milk cisterns are absent. The general anatomy of 
the milk glands has been briefly outlined on page 35. 

The variations in the structure of the milk glands in different 
animals are very interesting in relation to their tendency to disease. 
The highly-developed glands of ruminants, with a single large 
cistern and a very large excretory canal through the end of the 

939 



940 Veterinary Obstetrics 

teat, are subjected to very great danger from acute infection. 
In animals where extensive milk cisterns do not exist, like the 
mare, and in carnivora, which have no cisterns at all, the tendency 
to acute mammary infection is very much less. 

On the other hand, we find that in the carnivora, especially in 
the bitch, without any milk cistern, there is a pre-eminent ten- 
dency for the glands to become the seat of malignant new-growths. 
When infection occurs in the capacious single milk cistern of a 
ruminant, the entire quarter is almost inevitablj' involved. In 
those animals with two or more cisterns, or with numerous milk 
canals without cisterns, a single lobule of the gland may become 
infected and the others remain sound. 

For convenience of description we may divide the diseases of 
the udder into : (i) Acute Infections, (2) Chronic Infections, 
(3) Wounds and Injuries, (4) Neoplasms. 

Acute Infections of the Mamm^. Mammitis. 
Mastitis. 

Mammitis consists essentially of an infection of the mammary 
gland, and, like the infections of other organs or tissues, may be 
extremely variable in character. The different species of domestic 
animals show great variations in their susceptibility to mammitis, 
and in the type or types which the disease may assume. By 
some authors, the inflammations of the gland have been divided 
into catarrhal, phlegmonous and interstitial mammitis. Others 
add to these, purulent and gangrenous mammitis. 

Until we understand better the exact nature of the various 
forms of mammitis, especially in relation to the bacteriologic 
cause of each, any cla.ssification which may be made is merely a 
matter of convenience for purposes of description, which may 
facilitate our understanding of certain more or less distinct types 
of disease observed. 

The various species of domestic animals show such marked 
differences in the prevailing type or types of diseases of the milk 
glands that it is advantageous to consider those of each species 
separately, although in many respects they may be identical. 

a. Mammitis or Mastitis in the Cow. 

The cow constitutes the chief dairy animal, for which purpose 
she has been specially bred for centuries, and has been brought 



Acute Matnmitis 941 

to a high state of perfection as a milk-producing animal. With 
this specialization of function, there has arisen a vulnerability of 
the milk glands to injuries and diseases, which surpasses that seen 
in any other domestic animal. We consequently meet with a 
great variety of inflammatory diseases of the milk glands in 
cows. These variations are due in part to the intensity of the 
infection and the comparative power of resistance of the gland, 
and are in large part due to the specific differences in the infec- 
tions themselves. 

Mammitis in dairy cows has a wide economic and sanitary in- 
terest. The pathologic milk of mammitis is usually rejected as 
human food by the repulsive taste, smell or visible appearances. 
Pathologic milk, unrecognizable by the special sen.ses, like that 
from a tubercular udder, may possess far greater danger for man. 

According to the avenue of infection, the inflammations of 
the mammary glands may be divided into two groups, very un- 
equal in size and importance : 

1. The infections which gain entrance into the cavit}' of the 
milk gland from the exterior, through the milk orifice or orifices 
in the teat, or through some wound involving the tissues which 
constitute the walls of these cavities. 

2. A lesser group of infections, which reach the tissues of the 
gland from some other portion of the body, through the medium 
of the lymph or blood channels, e. g., tubercular mammitis. 

I. Acute Mammitis. Acute Mastitis. 

Acute mastitis may be defined as an infection of the milk 
gland, due to the entrance into its substance of the micro-organ- 
isms ordinarily inducing wound infection. We might liken 
acute mammitis to wound infection itself, and regard the epithe- 
lial lining of the milk cisterns, ducts or acini, or all these areas 
combined, as representing the wound area %vhich has become 
infected. 

As in wound infection, so in acute mammitis, the infecting 
agent may be of ver3' diverse character. Investigators, in deal- 
ing with acute mammitis, have found virtually all the types of 
organisms which are recognizable in wound infection, such as 
diplococci, streptococci, staphylococci and bacilli. 

In accordance with the clinical history of wound infection, 



942 Veterinary Obstetrics 

some have believed, with apparently good reason, that there 
are variations in the virulence of mammitis, somewhat in harmony 
with the species of the infecting agent. As in ordinary wound 
infection, so in mammitis, streptococci apparently lead in viru- 
lence, while the staphylococci are believed to induce a milder 
form of inflammation. 

The avenue of entrance of the infecting organisms is regularly 
through the orifice of the teat. Their source of origin may 
offer great variety, but ordinarily the infecting organisms are 
abundant, and only require some favorable opportunity for pass- 
ing through the teat orifice and gaining the interior of the gland. 
The more abundant and virulent the micro-organisms in the imme- 
diate environment of the cow, the more probable the infection. 
The bedding, floor aud stall con.stantly afford more or less infective 
material, the virulence of which may be partly dependent upon 
the cleanliness of the stall, but in the main is not understood. The 
dairyman may reduce the degree of filth, and hence of infection,, 
to the minimum. Accidental conditions which we do not under- 
stand sometimes seem to cause a sudden increase of virulence or 
volume of infection in the stable, which may express itself for a 
time in the form of enzootic mammitis. 

In a large proportion of cases, there are good clinical evi- 
dences of the source of origin of the infecting material. When- 
ever a suppurating wound exists upon a teat, or some adjacent 
part of the udder, and the pus has an opportunity to flow down 
the teat to come in contact with the teat orifice, mammitis al- 
most invariably follows, unless some adequate precautions are 
prompth' taken by the veterinarian to bar the entrance of the 
infection through the milk canal. Retained and decomposing after- 
birth, or any putrid discharge from the uterus or vagina, always 
tends very strongly to induce mammitis. The pus flowsdown over 
the thighs and udder, and thence along the teat, naturally the 
posterior teat, and, gaining the apex of this, the infection finds 
its way upward through the orifice in the teat, and mammitis at 
once results. Possibly more direct and effective is the infection 
through the teat orifice, when a retained afterbirth hangs down 
so low that it comes in direct contact with the teat and is actually 
pressed against the teat orifice. Or the tail, saturated with the 
discharges from the vulva, may be lashed against the ends of the 
teats and force the infection into the teat orifice. Not only may 



Acute Mam^nitis 943 

such a cow bring about an infection of her own udder, but with 
her soiled tail she may convey the infection to another cow in an 
adjacent stanchion, or the neighboring cow may strike her tail 
against the soiled parts of the diseased animal, and thence carry 
the infection to her own udder. 

There is frequently convincing clinical evidence that a milker 
carries the infection to a healthy teat. He may get the infec- 
tion upon his hands from an animal which is suffering from 
mammitis, and may readily convey it to another teat of rhe same 
uddeir, or, without washing his hands, may carry it farther and 
deposit the infection upon the teats of a healthy cow, and induce 
the disease. It is not essential that the milker should get the 
infection from a diseased milk gland. He can as readily and 
as seriously infect his hands by handling a putrid afterbirth, or 
an aborted fetus, or an infected wound upon any animal, and, by 
negligence or oversight, carry the infection to the udder of a 
healthy cow. 

It has been suggested that, when cows lie down, straws from 
their bedding may be pushed through the orifice into the milk cis- 
tern and carry with them virulent and infectious material, and 
there have probably been sufficient observations upon this point 
to establish the fact that such infections really occur. Every 
veterinarian in dairy practice has probably observed numerous 
cases of infection by means of the milk tube. La3'men very 
generally believe that they can meddle with the inside of a cow's 
teat with the same degree of abandon with which they may 
handle the outside, and many of them do not hesitate, upon the 
least excuse, to insert a milk tube, a sound, a wire, a knitting 
needle, or almost any implement, into the teat, and do not an- 
ticipate therefrom any serious consequences. 

Thus, in many ways infection of a virulent character may be 
forced through, or find its entrance into, the milk cistern. 
Once it has reached the milk cistern and milk canals, it is in a 
favorable environment for growth. The infection may then ex- 
tend according to virulence and the resistance of the tissues, 
along the larger, and thence along the smaller milk ducts, and 
may finally reach the milk acini and attack the secretory epithe- 
lium of those structures, and produce any symptoms or patho- 
logic conditions which the various forms of organisms are capa- 
ble of inducing in such tissues. 



944 Veterinary Obstetrics 

The handling of parturient paresis by intra-mammary injection 
is a fruitful source of raammitis, as already related while discuss- 
ing that affection. 

Most infections of the body have been attributed to " taking 
cold," and it is assumed that mammitis may be caused or its 
establishment favored by exposure to cold, dampness or drafts. 
Perhaps these factors do depress the system and favor the advent 
of mammitis. 

Contusions exert an important induence by devitalizing the 
tissues and rendering them more vulnerable to infection. Thus 
a very pendent udder, buffetted back and forth between the legs 
of a rapidly moving cow, may seriously contuse the gland and 
destroy its normal power of resistance. A rough milker may 
readily induce contusions of the udder which may do much to 
cause mammitis. 

It is unnecessary for the infection to be introduced immedi- 
ately' from the outside. The teat orifice and lower part of the 
cistern already contain, in the milk, some bacteria, usually of a 
kind not pathogenic for the parts so long as the gland is not dis- 
turbed. Whenever the gland is contused, or other accident occurs 
to depress the vitality of the tissues, the hitherto harmless (sap- 
rophytic) bacteria, may become pathogenic. 

When the uddei is overdistended, the tissues become weakened 
and infection is favored. The whole udder projects very promi- 
nently in the cow, and is accordingly exposed to injury. The 
posterior teats are shorter than the anterior, are more rigid, and 
are directed more or less backward in a direction which renders 
them more susceptible to injury from pressure and from dirty 
bedding-straws being pushed through the orifice into the milk 
cistern. 

Symptoms. Mastitis occurs almost wholly in cows in full 
milk, and chiefly very soon after calving. It is at this time 
that the udder is most active, and consequently offers the great- 
est vulnerability to infection, and it is at this period that the 
udder is most exposed to virulent infections of various kinds. 
The maximum distension of the udder subjects the secretory 
tissues to a compression, which, if not promptly relieved by milk- 
ing, lowers the powers of resistance in the parenchyma of the 
gland. At the same time, the engorgement causes the udder to 
oroject farther, more directly and rigidly from the body walls, 



Acute Mammitis 945 

exposing the udder and teats to increased danger from contu- 
sions and abrasions ; intensifies the danger of forcible contact 
of the teat orifice with infected objects ; and favors the entrance 
into the teat of straws or other rigid infection-bearing bodies. 
The disease may occur, however, at any date during the period 
of milking, or in the dry cow. We have observed the disease 
in heifers. 

Usually only one quarter of the udder, most commonly a pos- 
terior one, is involved. The disease may simultaneoush' or con- 
secutively affect two, three or all of the quarters. 

The period of incubation in acute mammitis is brief. Experi- 
mental infection has induced the symptoms of mammitis in 12- 
24 hours. We also observe a similar period of incubation clini- 
call3' following operative interference of the mammae. The 
forcible insertion of a milk tube ; the inflation of the udder in 
milk fever ; or the overcoming of atresia of the teat by incision 
or puncture is frequently followed by mammitis in 1 2-24 hours. 

Lameness is a common and early sj'mptom of the disease. 
It is frequently the first symptom observed by the owner, 
though it may occur at any time during the disease. The lame- 
ness may be referable to three different causes. 

1. In the first stages of the disease, the owner may observe 
lameness as the first symptom of mammitis. In such cases the 
lameness is apparentlj- an expression of pain in the affected 
quarter or quarters. The lameness may be more severe when a hind 
quarter is involved than when an anterior one is affected, because, 
in progression, the posterior quarter is more severely compressed 
or contused by the hind leg as the limb is carried forward and 
weight placed upon it. Doubtless not all the pain and conse- 
quent lameness is due to the sensitiveness of the affected quarter, 
but must be largely referred to lymphangitis or phlebitis of the 
chief mammary veins and lymphatics in their course through 
the inguinal canal, where any tenderness causes intense pain dur- 
ing any movements of the limbs or bodj' which may bring into 
play the surrounding muscles. When both sides of the udder 
are simultaneously inflamed, the disinclination to move becomes 
very strong, with evidences of very great pain. 

2. Pyaemia arthritis may arise at any time during the affec- 
tion, as a complication of mammitis, and induce symptoms par- 
allel in all respects with the pysemic arthritis already described 

60 



946 Veterinary Obstetrics 

on page go2 as a sequel to puerperal infection. Such arthritis 
cannot be differentiated from that arising from septic inflamma- 
tion of the uterus, except it occurs at a time when the uterine 
avenue of infection may be excluded. 

3. Paretic lameness or paralysis occasionally accompanies 
mammitis, and appears in two somewhat distinct forms. 

a. Acute mammary gangrene with acute septicaemia fre- 
quently causes rapid and complete paralysis of the posterior 
portions of the body. 

In particularly stormy mammitis with gangrene, complete par- 
alysis has sometimes been the first symptom observed by the 
owner. During the night, or other interval without observation, 
other preliminary symptoms may have come and gone, and when 
first observed the cow is prostrate and unable to rise. 

b. Mammary toxaemia or pseudo-parturient paresis may 
occur in very mild, insidious cases of mammitis. Ere the 
owner or veterinarian realizes or suspects serious consequences, 
the cow goes down, is more or less completely paralyzed, her 
temperature may be sub-normal, and more or less marked coma 
may appear. Two facts serve to differentiate this from parturient 
paresis. It occurs, or may occur, four to six weeks after partu- 
rition, perhaps in an animal not a good subject for parturient 
paresis, and a history of the case will reveal the existence of a 
more or less evident mammitis. According to our observation 
the mammitis in such cases has been of a very mild type, slight 
swelling, the disease apparently confined chiefly to the milk 
cistern and ducts and accompanied by well marked, though not 
extreme, changes in the secretions of the affected quarter. The 
milk had for a few hours been thin, wheyey and flocculent, but 
not fetid. 

Apparently such paralysis is due to toxsemia from the absorp- 
tion of bacterial products from the diseased udder. In one case 
observed by us, inflation of the udder with oxygen promptly 
overcame the paralysis and coma, and apparently also disinfected 
the diseased quarter. 

The local symptoms of mammitis consist essentially of the 
cardinal symptoms of inflammation, with the various conse- 
quences of inflammation in these tissues. 

Heat is usually a prominent symptom in the affected quarter, 
and is very readily recognized by the sense of touch, especially 



Acute Manimitis 947 

when compared with an adjacent healthy quarter. The intensity 
of heat is not indicative of the seriousness of the inflammation 
within the gland. The inflammatory processes may be chiefly 
taking place in the central portion of the gland, and the skin 
may be but slightly involved. While the presence of heat may 
aid in the diagnosis, it is of comparatively little value as an aid 
to prognosis. 

The pain in the inflamed gland shows every possible variation 
in intensity. As in the case of heat, so the degree of pain does 
not reveal the seriousness or extent of the malady. As a general 
rule, the pain is most marked upon pressure when the disease is 
largely concentrated in or about the teat, that is, when the disease 
most seriously involves the more superficial, sensitive portions 
of the gland. There may be a deep-seated inflammation of the 
gland, which may be freely palpated without causing evidence 
of great pain. When necrosis occurs in any part of the gland, 
sensation in that portion necessarily ceases. 

The redness of the tissues is usually in harmony with the de- 
gree of heat and pain. When the inflammation is at all super- 
ficially located, the redness is usually very intense, and in marked 
contrast to the color of the adjacent healthy quarters. When 
gangrene occurs, and involves the skin, that portion which is 
gangrenous assumes a necrotic-black or necrotic-green hue, and 
the epidermis maj^ slip off upon touch, exposing the naked skin. 

Swelling constitutes one of the most prominent and important 
local symptoms. At the very beginning of the disease, the swell- 
ing is usually quite evident to both sight and touch. It becomes 
especially marked when the healthy quarters of the gland have 
been milked out. Upon manipulation, the diseased quarter is 
found to be more or less extensively enlarged, sometimes to double 
the size of the corresponding normal quarter when filled with 
milk. There is, however, a somewhat definite limit to the rapid 
swelling of the gland, owing to the very inextensible gland cap- 
sule. As the inflammation continues, the capsule may become 
slowly increased to an enormous size. 

There are variations in the character of the swelling, depend- 
ent somewhat upon the chief center of the disease and the viru- 
lence of the infecting agent. When the inflammation is deep- 
seated, the external appearances of swelling may consist very 
largely of edema, which appears subcutaneously about the upper 



948 Veterinary Obstetrics 

part of the udder, and may extend forward along the floor of the 
abdomen toward the anterior limbs, and upward and backward 
between the thighs to the vulva and perineum. Sometimes the 
volume of the edema is very great, while at other times edema 
may be virtually absent. 

In other instances, the swelling assumes, instead, the character 
of induration, or we might say it is chiefly within the capsule of 
the gland, involving the glandular and interlobular connective 
tissues and, b}' causing parenchymatous engorgement, stretches 
the gland capsule tight and causes a firm compression of the 
contents within. Manipulation of the diseased quarter reveals 
great tenseness and hardness in the deeper parts of the organ. 

When suppuration appears, and pus is formed, there soon 
occur the cardinal symptoms of abscessation, with the prominent 
firm swelling, redness and pain, to be followed by fluctuation. 
Usually there is a single abscess involving much or all of a 
quarter. Rarely one, two or all the quarters become the seat of 
multiple recurrent abscesses, the udder enormously enlarged, 
with abscesses scattered here and there, discharging copiously a 
thick, fetid pus. 

When gangrene supervenes, the redness, pain and heat may 
disappear, the swelling may become softer, and, if the skin is in- 
volved, the surface becomes cold and the epithelium is readily 
displaced. 

When the disease continues for a long period of time, and 
enters upon a chronic state, sclerosis, with absence of pain and 
heat, may follow, and the gland assume an enormous size. 

The disturbance of function in the gland is one of the most 
marked and important symptoms of maramitis. From the very 
first, there is a more or less marked decrease, or a total suspension 
of the secretion of milk in the affected quarter. At the same time, 
there usually occurs a more or less marked diminution in the 
amount of milk secreted by the apparently healthy quarters. 

The changes in the character of the milk are highly important, 
and reveal to a certain extent the virulence of the malady. The 
milk loses its neutral or faintly alkaline character, and becomes 
somewhat acid. The casein becomes precipitated and flocculent. 
The clumps of casein may be so tough and of such large size as to 
render it difficult or impossible for them to be forced out through 
the teat orifice. In many cases they probably remain incarcerated 



Acute Mamniits 949 

in the larger milk ducts, to add to the engorgement of the gland. 
The liquid portions of the milk are watery, and vary in color 
according to circumstances. Usually in the earlier stages the 
liquid portion of the milk is white, faintly bluish-white, or yellow. 
Sometimes it is streaked with blood, or merely somewhat tinged 
with blood, to give it a faint reddish color. When gangrene ap- 
pears, the liquid which may drip or be expressed from the teat 
has a tell-tale necrotic-red color, which at once reveals the con- 
dition of the deep-seated tissues. 

The albumen in the milk may be increased ten-fold ; the salts 
may be largely increased ; while the fat and casein almost dis- 
appear. Sometimes the contents of the milk cistern are princi- 
pally or wholly of pus. 

The milk may be either odorless or more or less fetid. In 
many cases, when the diseased liquid is pressed out from the teat 
and caught, it is found to be extremely fetid, giving off the odor 
of fetid pus from wounds. In gangrene, the typical gangrenous 
odor may be present in the fluid. The taste of the diseased milk 
shows every possible variation, usually is somewhat salty or may 
be bitter. 

Bacteriologically, the discharge from the gland may be highly 
variable, and include, as already suggested, various forms of 
diplococci, streptococci or bacilli, and other organisms char- 
acteristic of wound infection. The infection may be pure or 
mixed. 

The systemic disturbances of mammitis are not always in 
harmony with the extent and intensity of the local lesions. 
Usually, in severe, acute mammitis, there are well-marked sys- 
temic disturbances, consisting essentially of fever or septicaemia. 
In very acute cases of mastitis, we have observed the tempera- 
ture rise suddenly, reaching 106° F. within twenty-four hours 
from the time of infection. Generally, when there is an ex- 
tensive inflammation of the udder, a more or less marked fever 
is present, with all the symptoms which that term usually 
includes, such as loss of appetite, torpidity of the bowels, dry 
muzzle, suspension of rumination and decrease of thirst. The 
urinary and other functions are decreased, and there is more or 
less profound depression. In the early stages of the disease, 
there may be chills, with staring coat. When 'the disease be- 
comes very severe, there ensues a loss of sensibility, and the 



950 Veterinary Obstetrics 

patient ceases to care for her calf and becomes more or less un- 
conscious of her surroundings. When gangrene is threatened or 
present, there may be more or less complete paralysis, as already 
stated ; or a somewhat similar paralysis may occur sometimes as 
a result of intoxication owing to absorption from the udder of 
bacterial products, in comparatively mild attacks. 

Course and Termination. In a large proportion of cases 
the course and termination of the disease is unfavorable. Even 
in those cases counted as recoveries, the glands are almost inevi- 
tably more or less damaged, and their function interrupted either 
temporarily or permanently. 

The complete loss of one or more quarters by atrophj^, indura- 
tion, abscessation or gangrene is common, resulting in a three-or 
two-teated cow of greatly diminished value. A three-teated cow 
may yield a high percentage of the normal amount of milk, but 
the diseased and functionless gland may constitute a menace to 
the adjacent quarters, and is unsightly and undesirable. When 
two quarters are lost, the decrease in the milk yield is so great 
that the value of the cow as a dairy animal is ordinarily at an end. 

The mortality from the disease is by no means insignificant. 
The disease may terminate in resolution ; abscessation ; chronic 
mastitis, with atrophy of the glandular substance, which may be 
accompanied by hj'perplasia of the connective tissue with indu- 
ration and enlargement ; gangrene ; pyaemia ; or septicaemia. 

a Resolution may occur early in the attack, at any period 
from the third or fourth to the eighth or tenth day, or even later. 
In very acute cases, resolution may follow in the course of a very 
few hours ; in fact, in some very virulent cases resolution must 
occur very quickly or the animal necessarily perishes. When 
resolution occurs, the swelling and pain in the udder abate, the 
appetite returns and the milk secretion becomes re-established, 
while the general appearance of the animal improves in harmony 
with the local conditions. The milk may remain somewhat ab- 
normal for a time. The milk flow very rarely recovers its normal 
amount, but remains somewhat lessened throughout the involved 
milking period. The volume may or may not become fully re- 
stored at the next calving. 

Vennerholm agrees with Franck that resolution seldom follows, 
while Stockfieth estimates that resolution occurs in at least 50% 



Acute Ma->nniitis 951 

of the cases. In our experience resolution has been very rare 
indeed. 

Too frequently the acute disease passes into the chronic form. 
If the changes brought about by the disease are not too serious, 
the period of rest, while the cow is dry, may afford an oppor- 
tunity for the complete resolution of the gland, so that when she 
again calves she may yield almost or wholly her normal amount 
and quality of milk. If the gland has been once seriously 
affected, it is rendered so vulnerable to any subsequent infection 
that the disease may at any time recur. 

b. Suppuration and the formation of abscesses may originate 
in any of the tissues of the gland — in the subcutaneous connec- 
tive tissue, the inter-lobular connective tissues, or the paren- 
chyma of the gland. 

In many cases we observe that the suppuration affects chieflj- 
the epithelium of the milk canals and acini, to constitute ca- 
tarrhal mastitis, in which case there may not be very extensive 
swelling, and the area of the disease may be more or less con- 
fined to the milk cistern and the larger milk canals, without in- 
volving seriously the acini themselves. Rarely an abscess 
fo:t:ms in the milk cistern, without involving the parenchyma 
of the gland at all. Abscesses in the milk cistern are very liable 
to cau.se the destruction of the milk canals, by causing their com- 
plete atre.sia, so that they can never re-open. The formation of 
abscesses in the udder leads almost uniformly to the permanent 
destruction of the involved quarter, though in rare instances 
there may be a partial restoration of milk production after the 
next calving. 

Purulent mastitis may lead, in somewhat rare instances, to 
pyaemia or to metastatic complications of the joints or tendon 
sheaths. Abscesses may become encapsulated, with indurated 
abscess walls which surround the pus, and continue as hard 
swellings in the affected part. 

c. Atrophy of the gland substance occurs frequently, with or 
without induration. 

Following many cases of acute mastitis, a chronic inflamma- 
tion remains, which causes, in addition to the atrophy of the 
substance of the gland itself, an extensive hyperplasia of the 
inter-lobular substance. The gland becomes indurated, hard, 
and incapable of secreting milk. The indurated gland may as- 



952 Veterinary Obstetrics 

sume enormous proportions, and finally take the character of a 
connective tissue tumor, and, hy its weight, drag the capsule of 
the quarter downward until it nearly reaches the ground. In some 
cows the indurated udder is so enormous in size, and hangs so 
low, that it interferes greatly with locomotion. It is constantly 
subject to injuries during the animal's movements, by coming in 
contact with obstacles of various kinds, which cause wounds 
and contusions and bring about infections of the enlarged function- 
less gland which may give more or less annoyance. 

At each birth period, also, indurated glands are liable to be- 
come congested and inflamed, and give rise to more or less serious 
complications. Such a gland is always beyond restoration. 

d. Gangrene. Gangrene constitutes the most serious termi- 
nation of mastitis, because it destroys absolutely the function of 
all that portion of the gland which is involved, and seriously im- 
perils the life of the animal. It occurs usually as a direct result 
of the intense infection of the part, which leads to the destruc- 
tion of the circulation in the affected gland. It may appear very 
quickly, or may be somewhat delayed in its advent: Gangrene 
may involve the parenchymal and inter- lobular tissues alone, or 
may include the skin. It may be confined to one of the quarters 
or a portion of it, or may involve the half or all of the gland. 
The gangrenous portion may partially undergo purulent destruc- 
tion. The surrounding parts may suppurate in such a manner 
that a sequestration of the necrotic tissue occurs, and the gan- 
grenous portion is later thrown off. 

In the more acute forms of gangrenous mammitis, the course 
of the disease is entirely too rapid and virulent for a sequestrum 
to form or suppuration to take place, and the animal dies very 
quickly from acute septicsemia or pyeemia. Few diseases run a 
more stormy course than the more acute types of gangrene of 
the mammae. In one instance, which we observed, a cow was left 
apparently well at milking time in the evening ; when found the 
next morning .she was down and unable to rise because of acute 
mammitis, which quickly advanced to gangrene of the organ ; 
she died during the day. Other instances have been observed 
where the disease has pursued a similarly rapid course. 

Pathology. The pathology of mammitis includes every pos- 
sible morbid change in an acinous gland, important changes in 
the milk secretions, and such systemic disorders as pyseraia and 



Acute Mammitis 953 

septicaemia, which may emanate from the disease processes in 
the g-lands. 

An incision through a milk gland recently attacked by mam- 
mitis, reveals engorgement, injection and hemorrhages in the 
parenchyma. The milk canals contain abnormal secretions, usu- 
ally flocculent in character, due to clots of casein. The groups 
of acini upon the cut surface appear as small yellow clumps. 
Serous or sero-sanguineous fluid may be pressed from the cut 
surface. 

If the disease assumes the catarrhal type, and limits its rav- 
ages chiefly to the epithelium of the gland, the milk cistern and 
milk ducts usually contain muco-purulent or purulent secre- 
tions. The accumulated secretions may be thin and watery with 
caseous clots floating in them, stringy and tenacious, or purulent 
and fetid. 

Sometimes the disease may be limited to the milk cistern, and a 
catarrhal inflammation ensue with discharge of the pus through 
the teat orifice ; or the teat orifice may become blocked, con- 
verting the cistern temporarily into an abscess cavity, which 
eventually ruptures by re-opening of the milk orifice, and the dis- 
charge of the accumulated pus follows. Such an abscess tends to 
cause permanent atresia of the larger milk ducts and, preventing 
the escape of milk into the cistern, produces engorgement of 
that portion of the gland from which the affected duct normally 
serves as an outlet. L,ater the engorgement destroys the secre- 
tory power of the part, and there may remain for a time an im- 
prisoned volume of milk — a " milk cj'st." Catarrhal inflamma- 
tion of the milk cistern may lead to atresia or adhesions in any 
part of the cavity. Sometimes the entire milk cistern becomes 
occluded, the cistern walls adhere from the base to the apex of 
the teat, and even though the gland itself may escape destruc- 
tive inflammation, it is later doomed to pressure atrophj' from 
the compression of the imprisoned milk. Such adhesions occur 
most readily in the dry cow or heifer, when the changes named 
are not interrupted by a constant flow of milk into the cistern. 

When the catarrhal inflammation extends to the smaller milk 
ducts and acini, the secretory epithelium is more or less injured 
or wholly destroyed, while the cavities of the acini become oc- 
cluded with exudate. I,ater the glandular tissue may undergo 



954 Veterinary Obstetrics 

atrophy. The atrophy may be intensified and increased by 
hyperplasia of the inter-lobular connective tissue septa. 

Treatment. The treatment of manimitis is necessarily unsat- 
isfactory. 

The anatomy of the gland is such that when the tissues be- 
come infected there is no known method of reliable, disinfection. 
Acute inflammation of the parenchyma at once causes the milk 
ducts and acini to become filled with exudate. Into these 
blocked passages we are powerless to introduce remedies, and 
from them we are alike powerless to extract the exudate. The 
gland is firmly bound down by its very tense fibro-elastic cap- 
sule, derived from the abdominal tunic. When the imprisoned 
gland becomes inflamed and swollen, great pressure is at once 
exerted upon its substance by the unyielding capsule, its circula- 
tion is impeded or suspended, and the infecting agent is afforded 
an excellent opportunity for rapid multiplication and destructive 
activity in the weakened tissues. Further complications arise 
from the dependent position of the gland, which interferes seri- 
ously with the return of the venous blood. 

As in all diseases where no specific method of handling has 
been devised, so in mammitis, an almo.st endless variety of means 
have been suggested, tried, approved or condemned. It is im- 
practicable to relate each method of handling, nor would it be 
profitable. 

The various forms of handling may be more or less definitely 
classified. 

I. Disinfection. Since acute mammitis is referable to infec- 
tion, the most rational course for treatment, the one which 
technically appeals most directly to reason, is disinfection. Un- 
fortunately, as already stated, we have no efficient plan for bring- 
ing this about. Three plans for disinfection'.have been tried, 
and each has had its champions, possibly because each possesses 
some degree of eiSciency. 

a. Intra-mammary injections of disinfectants have long 
been practiced and advised by some veterinarians, but the plan 
has never acquired general adoption. - Nocard, Franck and 
other authorities have reported favorably. Vennerholm, Zschokke 
and other equal authorities have failed to secure benefit from 
this method of handling. In our hands, a 2 @ 5% boric acid 
solution, injected into the udder by gravity, has not only 



Acute Maimnitis 955 

failed to reduce the infection and inflammation but has appar- 
ently intensified the disease. 

In the healthy udder, only a small amount of fluid can be 
introduced under a gravity pressure of three or four feet. We 
have succeeded in this manner in injecting little more than a 
pint into a quarter from which five to eight times that volume of 
milk had been withdrawn. This signifies that, in the healthy 
udder, fluids injected through the teat pass into the cistern and 
larger milk canals, but not into the smaller milk ducts and the 
acini. 

In the vast majority of ca.ses of mammitis, the small ducts 
and acini, not the milk cisterns and larger canals, constitute 
the chief center of disease. Fluids injected into the udder 
usually reach the least important part of the gland only — the 
cistern and large canals. As a consequence, not much can be 
expected from this plan of handling. If the disease is largely 
centered in the cistern and large sinuses, disinfection by intra- 
mammary injections may prove highly efficient, but such cases 
are in the minority. 

The selection of a disinfectant for such purpose is not highly 
important, though certain principles may have clinical import- 
ance. Boric and other acids tend to coagulate any casein or 
albumen present. The same holds true of mercuric chloride, 
and the salts of the heavy metals generally. Carbolic acid, 
creolin and allied drugs are highly irritant. Probably lysol, 
bacillol and other drugs of this group are most useful for 
injection. 

Whatever disinfectant is employed, it must be in very weak 
solution. Of lysol or bacillol, not to exceed 0.5% should be 
used. The chief reliance should be placed upon the irrigation 
of the cistern and sinuses with the warm water, rather than 
upon the efficiency of the antiseptic contained. The various 
soluble silver salts have been proposed for this purpose, but have 
failed to secure a prominent place. 

b. Disinfection by external applications is an old plan of 
handling. Probably in many cases, the practitioner has not had 
disinfection in mind when applying it. Camphor, iodine and 
mercury, in combination with various substances, have long been 
used in the form of ointments thoroughly anointed over the 
affected area. Their value has been stoutly asserted by practi- 



956 Veterinary Obstetrics 

tioners like Johne, Bang and Franck. They probably exert some 
favorable influence as disinfectants. It is possible, however, 
that the massage used in applying the ointment constitutes as 
great, or even a greater, factor than the absorbed portion of the 
ointment. The drugs named are also rubefacients, and may 
favorably affect the diseased gland by exciting increased vas- 
cularity with exalted leucocytosis. 

c. Systemic disinfection in mammitis has not yet received 
much attention. How effectively it may be employed remains to 
be determined. We know that potassium iodide exerts a some- 
what specific effect, when given internally, upon lesions of acti- 
nomycosis and botryomycosis — chronic infections which are not 
wholly unlike the acute infections of ordinary mammitis. 

Aromatics and gum resins, when given to healthy, lactating 
animals, are recognizable in the milk by the sense of odor and 
taste. Most of the.se drugs, like camphor, turpentine and the 
aromatic oils, are efficient disinfectants, and given in full doses 
tend somewhat to lessen infection in the mammarj^ gland. 

2. Modifications in the blood-flow to the udder have been 
claimed to affect the course of mammitis. In former times practi- 
tioners aimed to reduce the intra-mammary blood pressure by 
means of venesection. L,ocal applications of camphor, belladonna 
and other drugs have been made, in the belief that they decreased 
the amount of blood sent to the udder, though the truth of this 
has not been clearly shown. On the other hand it is not impos- 
sible that they increase the blood supply and also the leucocy- 
tosis, through which the treatment may act favorabl}^ upon the 
diseased organ. 

Just as in the application of antiseptics, so here the massage 
incident to application ma}^ exert the chief favorable influence. 

Cold has been used and advocated by some, either cold water 
or ice being applied to the inflamed gland. It has not proven of 
any marked value. Its tendency is to cause decreased vascu- 
larity during the continuance, to be followed by increased blood 
flow and vascular engorgeiuent as soon as the cold is withdrawn. 

Fomentations with hot water, to which vinegar and various 
other drugs are added, have long been recommended, and with 
the accompanying massage, appear to exert a favorable influence. 
For this purpose, a sufiiciently capacious vessel should be filled 
with as hot water as the patient can bear, and the vessel placed 



Aaite Maniviitis 957 

directly beneath the udder. The fomentation and massage 
are then appHed, the bath being kept hot by repeated additions 
of hot water. 

It has been recommended also to modif}' the blood ilow in the 
mammae by suspension or compression of the glands. Some 
recommend that a three-cornered piece of cloth, of sufficient size 
to encompass the udder, be fitted with long straps, those 
from one corner passing up behind on either side of the tail, 
those from the other corners upwards along the flanks, and all 
tied securely over the loins. This may support the weight of 
the pendulous udder, exert some pressure upon it, and de- 
crease the engorgement of the gland. Some would cut holes in 
the suspensorium, through which the teats may project, so that 
the cow may be milked ; others advise that the teats be included 
in the bandage, and one corner detached while the cow is being 
milked. 

It has also been proposed to strap the udder tightly with strips 
of adhesive plaster, and to thereby exert compression upon the 
gland, but the plan has not come into general use, presumably 
because it has failed to produce the expected results. 

The form, direction and location of the udder of the cow render 
suspension and adhesive strapping exceedingly difficult, and the 
efiiciency of neither has been demonstrated. It maj' well be 
questioned whether the inevitable partial displacement of such 
appliances, when the animal lies down, does not induce injuries 
which more than counterbalance anj' possible good it is hoped 
to derive from the strapping or suspension. 

With the aid of the suspensory bandage, poultices were for- 
merly applied to the inflamed udder. Thej' were highly com- 
mended bjr many, but their use has been largely discontinued. 
They are difficult of application and retention, and their value 
is very problematic. 

Instead of attempting to decrease the blood flow to the in- 
flamed gland, some would increase it. This is probablj' in a 
measure brought about by massage and by the application of 
stimulating liniments. Cupping has also been tried. A cup- 
ping glass of sufficient size is fitted over the teat of the affected 
quarter, and the air exhausted. This maj' cause the discharge of 
quantities of secretions which could not be withdrawn by milking, 
and stimulates increased nutrition in the diseased tissues. 



958 Veterinary Obstetrics 

Modern therapeutics recognizes the value of increased numbers 
and activity of leucocytes in a diseased area. Cupping, massage, 
repeated milking, fomentations, and the application of stimulating 
liniments or ointments, all probabl3' favor leucocytosis. It may 
be that the chief value of each of these applications lies in this 
influence upon the abundance of leucocytes in the part. 

3. It has been proposed to exert a favorable influence upon the 
course of mammitis by decreasing the flow of milk. In a way, 
this plan is closely allied to the decreasing of the blood supply to 
the gland. In considering the symptoms of the malady, we had 
occasion to note the inevitable decrease of milk secretion, or even 
its total suspension, as soon as mammitis becomes established. 
The artificial checking of the secretion of milk is usually quite 
unnecessary ; it becomes checked or suspended as an inevitable 
consequence of the disease. Not only is the secretion of milk 
decreased or suspended in the affected quarter, but also in the 
sound areas of the gland. 

Nevertheless many practitioners would have us decrease the 
milk secretion by the application of belladona or camphor to the 
exterior of the affected gland. Others recommend reduction of 
lactation by a reduced diet or by laxatives or purgatives. 
Whether or not these be of direct value in precisely the way in- 
tended, is possibly of no great consequence. Two essential thera- 
peutic principles are involved : i . The maintainance of the vigor 
of the animal system^as a whole; and, 2. The placing of the 
diseased organ at rest. We cannot maintain the highest systemic 
vigor upon a too restricted diet, and it is equally injurious to 
overfeed. The forced feeding of dairy cows is highly inimical to 
the progress of mammitis, just as it is of any other serious organic 
malady. It is consequently important that, in mammitis, the 
food rations be adjusted to the needs of a sick animal, and this in 
itself will reduce the tendency to active lactation. For this pur- 
pose it is well to allow a restricted ration of bran, roots or grass, 
freely salted, to emphasize the laxative tendency. 

4. Elimination of disease products from the system. 
Acute mammitis is inevitably accompanied by the entrance into 
the system of important disease products which more or less se- 
riously affect the general health of the patient. These disturb- 
ances are reflected back to the affected organ, there to intensify 
the local disease. Not only is it important, for the progress of 



Acute Mammitis 959 

mammitis, that the animal system be kept in the most vigorous 
condition possible, but it is equally important that the disease 
products shall be promptly eliminated. 

Whenever these fail to be promptly eliminated, they at once act 
unfavorably upon the system, inducing fever, with its important 
train of symptoms. With the advent of fever, the kidneys, 
bowels and other eliminating organs fail to perform their normal 
functions. 

Mastitis in ruminants is especially marked by great torpidity 
of the digestive system : rumination ceases, the bowels are tor- 
pid, digestion is at a standstill, the aliment within the canal 
tends to undergo decomposition, and waste products which are 
normally eliminated through this channel are retained within the 
system. 

It has accordingly long been the custom of veterinary practi- 
tioners to favor elimination hy stimulating the alimentary tract 
to increased activity. This is partly accomplished by a laxative 
diet, which in mild cases frequentl5' suffices. In the more serious 
cases, the patient does not eat, or for other reasons a laxative diet 
fails to produce the desired results and the practitioner needs ap- 
peal ,to more radical measures. 

The administration of purgatives in acute mammitis has ac- 
cordingly become recognized by many practitioners as highly 
valuable. Most practitioners rely upon the administration of 
magnesium, or sodium sulphate with various adjuncts. They 
have the common defect of inducing a degree of nausea, de- 
creased thirst and inappetence, which combine to retard or 
prevent catharsis. At best they are slow of action. Oils are 
little, if any, more effective. 

In our experience, the hypodermic cathartics — eserine, areco- 
line and pilocarpine, combined where advisable with strychnine — 
constitute the most reliable, prompt and efficient means for un- 
loading the alimentary tract. They save 12 to 20 hours in time, 
hours which may be of critical importance in the control of the 
malady ; they are safe and bear quick repetition when the dose 
proves too small ; and they possess very high efficiency. 

In one case occurring in our clinic, acute mammitis of a very 
virulent type, in all four quarters, followed the iodide of potas- 
sium infusion in handling parturient paresis. The temperature 
was 106° F., the pulse very rapid, the muzzle dry, the animal 



960 Veterinary Obstetrics 

extremely dull and weak and paying no attention whatever to 
her calf. The udder was immensely enlarged, hard and unyield- 
ing, and but a few drops of a thin, serous fluid could be pressed 
out of the teats. The general appearance of the animal indi- 
cated that the disease was progressing rapidly to a fatal termina- 
tion, and in our judgment the patient would not have survived 
many hours under the usual methods of treatment. 

We ignored the local handling of the organ, and instead in- 
jected a full dose of eserine sulphate and pilocarpine hydro- 
chlorate hypodermically. The purgation and salivation were 
very prompt and decided. The improvement in the condition of 
the animal was also prompt and remarkable. The temperature 
fell at once, and continued to drop at the rate of more than ]°F. 
per hour, until it reached normal. The muzzle soon became 
moist, and the cow renewed her attentions to her calf. 

The engorgement of the udder diminished rapidly ; the gland 
quickly became less tense and hard, and milk soon reappeared 
in the gland. The recovery was as prompt as had been the onset 
of the disease, which had shown unusual virulence from the 
beginning. 

Vennerholm regards the repeated withdrawal of the milk or 
excretions representing it, and thereby the removal of so much 
infectious material, as one of the most important elements in the 
handling of acute mammitis in the earlier stages. He recom- 
mends that the milk which accumulates in the cisterns should 
be withdrawn at least hourly so long as there is a hope of bring- 
ing about the resolution of the gland. He very properly re- 
marks that the infectious fluid should on no account be deposited 
upon the stable floor, but should be milked directly into a con- 
tainer partly filled with a reliable disinfectant. Too much reli- 
ance should not be placed upon the withdrawal of the small 
amount of fluid which has accumulated in the milk cistern. In 
most cases of acute mammitis, the amount of this is not large, 
although we know full well that it is highly infected, and may 
consequently look upon its retention in the cistern and sinuses 
as very undesirable. The important pathologic changes are tak- 
ing place chiefly in the acini, and not in the milk canals or cis- 
tern, and such influence as we may be able to exert upon the 
large milk canals and their reservoirs is not of fundamental 
importance. Our anxiety is centered upon the acini themselves. 



Acute Manimitis 961 

While the infection has admittedly entered through the milk 
cistern and the milk canals, nevertheless after the infection has 
traversed these parts and reached the parenchyma, the import- 
ance of these canals in the course of the disease has been largely 
eliminated. 

When considering the sj^mptoms of acute mammitis we have 
referred to the advent of coma in rare cases, and have stated that 
in at least one instance the inflation of the udder with oxygen over- 
came the coma, and apparently at the same time eliminated the 
infection. In ordinary mammitis it would appear that inflation 
with air or oxygen would prove valueless. 

As in other infections, so in mammitis, it has been hoped that 
curative sera may be devised which may be turned to practical 
account. The uncertain and usually mixed character of the in- 
fection constitutes a serious obstacle to serum therapeutics. 

Cows which are suffering from mammitis should be milked by 
a person who does not come in contact with the other cows, or 
should be milked last, so that the milker may not pass from 
the diseased cow immediately to a healthy one, with the possible 
danger of transmitting the disease. The same rule should be 
applied to the healthy portions of the gland of an animal suf- 
fering from the disease ; the healthy quarters should be milked 
first, followed by the milking of the diseased ones. 

Disinfection of the udder externally is of very great impor- 
tance in the control of the disease. Before beginning to milk an 
affected gland, the entire udder should be thoroughly disinfected, 
and after the milking of the diseased gland has been completed 
it should again receive thorough disinfection. The milker should 
also very thoroughly disinfect his hands before and after the 
milking, and especially should always most thoroughly disinfect 
his hands after having milked a diseased gland before he milks 
or otherwise handles the udder of a healthy cow. The best dis- 
infectant for this purpose is i-iooo corrosive sublimate solu- 
tion, because of its high efSciency and freedom from odor, so that 
if used in a stable where milking is going on, there is no danger 
of causing the milk to become tainted. 

In stalls where mammitis exists, great care should be taken to 
thoroughly cleanse and disinfect the floors and gutters, in order 
to prevent the spread of the infection from animal to animal. It 
61 



962 Veterinary Obstetrics 

is important also, as has been suggested in dealing with the 
causes of the disease, that the tails of neighboring cows should be 
kept disinfected, or, preferably, that a cow suffering from mam- 
mitis should not be kept so near to a healthy cow that a transfer 
of the infection from one to another, through the medium of the 
tail or otherwise, is probable. 

In wounds of the teats or udder, it is highly important that 
the disinfection of these should be as complete as it is in the 
power of the practitioner to command,. in order to avoid the en- 
trance of infection through the teat orifice into the gland. In 
dealing with metritis, or other disease accompanied by infective 
discharges from the vulva, which may flow down over and soil 
the udder and teats, the practitioner should exercise care in order 
to prevent the infection from gaining entrance into the teats. 

The surgical handling of mammitis consists in the opening of 
abscesses, the detachment of necrotic areas, or the amputation of 
the gland. 

The handling of abscesses of the mammae offers few special 
problems as compared with the handling of abscesses of other 
portions of the body. Following the general rule of procedure, 
they should be opened as early as fluctuation is clearly present ; 
the opening should be free and dependent as in other abscesses ; 
the abscess cavity should be thoroughly disinfected and any ne- 
crotic tissue lying within the cavity should be removed. 

In some instances of suppuration, the pus collects very largely 
in the milk cistern and is discharged through the orifice of the 
teat. In some cases this discharge of pus is not as free as should 
be, and it is occasionally advisable to amputate the end of the 
teat in order to secure a perfectly free opening. The question of 
the preservation of the teat is usually of no significance, because 
the quarter has lost its power of again secreting milk and is 
consequently useless. 

In some instances of severe mammitis, with great enlargement 
of the udder and extreme tension of the capsule of the gland, 
the virulence of the disease may be largely overcome by long 
and deep scarifications, by which the capsule is incised at a 
number of places in such a manner as to relieve the compression 
of the gland. This may be followed by liberal bathing with 
warm antiseptic solutions. In this way gangrene of the gland 
may be avoided, and the inflammation largely overcome; but after 



Aaite Mammitis 963 

all no very useful purpose has been served, except possibly that 
the danger to the life of the animal has been lessened. The 
affected gland is destroyed, and consequentlj^ useless. Amputa- 
tion would generally be preferable. 

Whenever gangrene threatens the life of the animal ; when the 
udder is the seat of enormous abscesses which must eventually 
destroy the integrity of the gland and cause prolonged disease 
and loss of condition ; when tumors of large size or chronic in- 
flammatory processes with great enlargement and pendulousness 
of the udder exist ; or when the gland is the seat of actino- 
mycosis or botryomycosis, the udder should be amputated. It is 
impractible to amputate one of the quarters of the cow, since the 
twoquartersof one half are too intimately blended for separation. 

The cow is to be cast, and preferably secured in lateral re- 
cumbency. Vennerholm recommends dorsal recumbeuc}', but 
this is constantly objectionable in ruminants because such posi- 
tion tends to induce tympany, and consequently should be avoided 
as far as practicable. The patient should be secured by means 
of two stout ropes, one of which is to be attached to the anterior, 
and the other to the posterior feet. The patient is then to be 
extended by attaching each rope to a post or other secure fasten- 
ing, sufficiently far apart to allow the animal to be fully stretched 
between the two points. 

The question of anaesthesia is one upon which practitioners 
are not agreed. Vennerholm recommends complete general an- 
aesthesia. In our experience general anaesthesia in the ruminant 
is dangerous, because of the probability of food being regurgitated 
from the rumen and inhaled, to cause foreign body pneumonia. 

In one case of amputation of the udder in the cow, where the 
entire gland was removed, as it was completely gangrenous, the 
cow was in a comatose condition and required no anaesthetic, 
because, so far as could be seen, no sense of pain was induced 
in the animal during the entire operation. Neither is the opera- 
tion a very painful one in most cases, so far as can be judged by 
the character of the tissues involved. The principal pain is in- 
duced by the cutaneous incisions, and the ligation of the chief 
mass of inguinal vessels. The operator may consequently choose 
between general anaesthesia and local anaesthesia to the skin, 
followed by local anaesthesia to the vessels passing through the 
inguinal canal. 



964 



Veterinary Obstetrics 



With proper care in application, the local anaesthesia is efl&cient 
and ample from both humane and surgical standpoints, and is far 
safer than general anaesthesia in ruminants. 

If the entire udder is to be removed, it is most easily accom- 
plished by amputating the two halves separately. If the skin is 
healthy, enough of it should be retained to readily cover over 
the denuded tissues, though most of it would best be removed 
with the gland. A curved incision is made around the half of 
the udder to be removed, at such a point that sufficient skin will 
remain to properly close the wound. The incision should extend 
only through the skin into the subcutaneous connective tissue. 
The skin is separated, by means of the fingers or the scalpel handle, 




Fig. 142. Udder of Cow, showing Principal Bloodvessels. (Furstenberg). 

a Ext. pudic art. ; b Ext. pudic vein ; c Arterial twig to the lymph gland ; 
d Posterior mammary gland ; e Anastomotic twig of external pudic artery; 
g Larger venous trunk ; h Posterior mammary vein ; / Lymph gland ; 
m Milk vein ; o Ant. mammary vein ; r Lymphatic vessel ; t Nerve trunk 
(ilio-hypogastric and ext. spermatic). 



Infectious Mamniitis of Cows 965 

from the fibro-elastic capsule of the gland. As this division ap- 
proaches the base of the gland, the operator encounters the sub- 
cutaneous abdominal vein and a branch of the external pudic ar- 
tery, which should be ligated, preferably with a double ligature, 
in order to prevent a-nastomatic hemorrhage. 

Posteriorly the operator encounters branches of the external 
pudic vein and artery, which require ligation. As the operation 
extends upward, the capsule of the gland needs be detached 
from the abdominal tunic, of which it constitutes a part, and 
when the region of the external inguinal ring is reached the 
operator encounters the chief vascular supply of the gland, as 
the vessels emerge from the inguinal canal. These should be 
carefully and securely ligated en masse. Any failure to properly 
secure these vessels may lead to serious or fatal hemorrhage, as 
has been repeatedly observed. 

By properly dividing the connective tissue from these vessels, 
they may be readily bared for some distance, and a ligature 
passed around the group of vessels, which may then be divided 
with scalpel or scissors some distance beyond, leaving a sufficient 
stump to insure against displacement of the ligature. If these 
vessels are properly ligated, there can scarcely occur a serious 
hemorrhage from an}' of the others. 

If the other half of the gland is to be removed, the animal, if 
secured in lateral recumbancy, should now be turned to the op- 
posite side, and the operation repeated. 

The wound should then be thoroughly cleansed and disinfected, 
all blood clots washed carefully away, and all vessels which can 
be discovered properly secured, after which the margins of the 
wound should be trimmed in such a manner that they can be 
brought together in proper apposition, without being either 
stretched or flaccid. In the wound should be laid some anti- 
septic tampons, such as strips of iodoform gauze, in order to pro- 
vide drainage and secure antisepsis. 

2. Infectious Mammitis of Cows. Infectious 
Agalactia. " Gelber Galt." 

Messrs. Borgeaud, Nocard and MoUereau, Zschokke, Bang, 
Kitt and others, describe an epizootic form of mastitis in cows 
which sometimes occasions very serious losses. Zschokke asserts 



966 Veterinary Obstetrics 

that some dairymen dread the malady more than foot and mouth 
disease, so extensive are the losses sometimes occasioned in 
affected dairies. 

The malady has been observed chiefly in Switzerland, where it 
has been extensively studied. We have seen no definite account 
of the existence of the malady in America", but its chronic, in- 
sidious character renders its importation easy. It probably 
already exists in this country, and merely awaits recognition and 
report of its presence. 

The disease consists of a catarrhal mastitis accompanied by 
slight or inconspicuous tumefaction of the affected quarter or 
quarters. The onset is somewhat insidious. The gland does 
not swell greatly, if noticeably. There is little or no tendency 
to abscessation or gangrene, and no marked systemic disturbances. 

The milk from the affected gland diminishes in quantity and 
undergoes gradual changes in quality. It becomes serous, bluish, 
and more or less viscid or flocculent. Later the color of the milk 
may be reddish or brownish. It acquires a slight acid reaction, 
is odorless and has a salty taste. 

The affected gland, which at first was but little altered in size, 
consistency or temperature, begins after 2 or 3 weeks to atrophy, 
and the milk secretion largely or completely ceases. After 2 or 3 
months the gland becomes extremely atrophied and shriveled, and 
the gland tissue so far disappears as to be almost unrecognizable 
by palpation. After the disease has run its course, the gland re- 
mains functionless ,at least until the cow calves again, possibly 
permanently. 

Ibel ( Archiv. Tierheilk, vol. 30J found that the lacteal vesicles 
largely disappear, so that instead of 200-300 in a lobule, but 
15-60 could be found. The diameters of the lacteal vesicles 
were also greatly reduced. The acini were sometimes empty, 
sometimes contained granular leucocytes or albumen coagula. 

The interlobular connective tissue was found somewhat thick- 
ened and sclerotic. Ibel concludes that " gelber gait " at first 
consists of a comparatively mild parenchymatous mastitis, with 
the escape of leucocytes and albumen into the alveoli. 

The disease is highly contagious, and is readily transmitted 
from the diseased to the healthy glands of the same udder or 
from cow to cow, through the agency of the milker's hands. 

The cause is a form of streptococcus, which can readily be ob- 



Infectious Mammitis of Cows 967 

tained in pure cultures, and by which the typical affection can be 
experimentally induced. 

Zschokke recognizes two types of the disease — the curable and 
the incurable. The first is caused by a short streptococcus ; the 
latter by a long streptococcus. Apparentl}' this is a variation in 
the virulence of the same organism ; if very virulent it forms in 
long chains if milder in short chains. 

Zschokke insists that the microscopical diagnosis is practical, 
and fundamentally important. Not only would he differentiate 
microscopically between acute mammitis and infectious mammitis, 
but he would recognize, by the length of the cocci chains, the 
grade of virulence in individual cases of infectious mammitis. 
He considers the early bacterial diagnosis of the greatest import- 
ance in order that control measures may be properly instituted 
early in an outbreak. 

The handling of infectious mammitis or agalactia has proven 
unsuccessful. No method of treatment has been found which 
exerts any recognizable influence from an economic standpoint. 
Zschokke tried intra-niammary injections of potassium iodide, 
i-iooo, and itrol (silver citrate), 1-4000, but without result. He 
also, tried, in vain, subcutaneous and intra-mammar}' injections 
of anti-streptococcus serum. 

Cantharides and other stimulating applications to the udder 
reduced the infection ; but the milk flow was suppressed, the 
gland continued functionless, and the betterment was without 
economic value. 

The experiments of Zschokke convinced him that it is best to 
leave a milk gland, affected with infectious mammitis, wholly 
alone. If the milk is drawn from the gland, the free leucocytes 
are also extracted. If left alone, the leucocytes destroy the 
streptococci, especiall}- those in short chains. If the milk, or 
mammar}' excretion representing it, is left in the gland, not only 
do the leucocj-tes tend to destroy the cocci, but the spread of the 
infection to other quarters of the udder or to other cows is obvi- 
ated. So long as the infected excretions remain in the udder, 
they do no harm to the gland, but the affected gland tends more 
to recovery than if the excretions were removed. 

The most important feature of handling the malady is the pre- 
vention of its spread from diseased to healthy glands. Diseased 
cows should be as well isolated as practicable, and should be 



968 Vetermary Obstetrics 

milked by separate milkers, or, if by the same milker, they 
should be milked last. When the disease exists in a dairy, dis- 
infectants should be freely used on the milker's hands and the 
cow's udders, both before and after the milking of each cow. 

3. EXANTHKMA OF THE UdDER. ThE MAMMITIS OF CoW-POX 
AND PoCK-LIKE DISEASES. 

Pox of the udder is quite common in milk cows in some re- 
gions. Some hold that there is a true and a false pox, while 
others claim that the two alleged diseases are really identical and 
consist of the genuine cow-pox. 

Cow-pox is usually of a benign character, though at times it 
is severe and tends to produce mammitis. At the beginning of 
the disease there may be present the general symptoms of fever, 
including chills with constipation and a decreased flow of milk. 
This is followed in the course of a few hours by characteristic 
lesions of the teats and the parts immediately surrounding these, 
consisting at first of hypersemic areas, with swelling of the sur- 
rounding skin. The skin is tender upon handling, and the cow 
resists being milked. In the course of two or three days there 
appear distinct papules in the inflamed areas, which vary some- 
what in their appearance according to the color of the skin. If 
the integument is not too highly pigmented, the papules are 
surrounded by a red zone, and become pitted or pocked in their 
center. The contents of the papules are at first clear and lym- 
phoid in character, but later become cloudy and more or less 
purulent, and finally dry, to constitute a scab, which drops away 
in two or three weeks, leaving a reddish, depressed scar. 

Should the pustules be injured by careless milking or other- 
wise, and the crusts torn away, the disease processes become 
intensified, the ulcers extend, and perhaps those which are near 
together become confluent. The crusts forming over the surface 
are very extensive, and under repeated irritation the lesions tend 
constantly to grow worse. The eruptions do not all appear sim- 
ultaneously, but new crops arise from time to time, so that there 
may be fresh papules alongside the old crusts or ulcers. 

While the course of cow-pox is usually benign, in severe cases 
there is a tendency to the occurence of mastitis of a severe type. 
It is not known that the mastitis is due to the entrance of the 
cow-pox organism into the udder. It is probable that the pox 



E-xanthema of the Udder 969 

lesions upon the teat and udder cause a purulent infection, which 
furnishes a supply of highlj' virulent pus, ready to induce infec- 
tion at any time that it may chance to find entrance through the 
teat canal into the milk cistern and thence into the milk canals. 

The source and character of the infection of the cow pox is 
unknown. In some cases, however, it is traceable to vaccination 
in man. The milker may have been vaccinated, or may have 
handled the vaccination wounds in children or others who have 
been vaccinated, and thus may bear the disease, upon his hands, 
to the teats of the cows while milking. Once the affection has 
gained entrance into a dairy stable, it is readily transmitted by 
the hands of the milkers from one cow to another. 

The handling of cow pox in dairy cows is chiefly prophylactic, 
and consists of the application of the fundamental rules of disin- 
fection. So far as is practicable, the affected cows should be 
isolated from the sound ones, and should be milked last. If the 
disease exists in a dairy stable, the hands of the milkers should 
be thoroughly disinfected before and after the milking of each cow. 
In our judgment the best disinfectant for this purpose is corrosive 
sublimate, because of its efEciency and absence of odor. 

* ;i; % * * :|; 

We meet from time to time, in various localities, with other 
forms of exanthema of the teats and udder. 

In the vicinity of Ithaca, N. Y., there has prevailed from time 
to time a disease having the general clinical characters of an in- 
fection. So far as we have been able to observe, the disease is 
unaccompanied by the formation of vesicles, pustules or other 
lesions to definitely identify it with cow-pox. At first there 
appear small inflamed areas in the skin of the teat or contiguous 
parts of the udder. Later the areas become hemorrhagic, and 
finally necrotic, when they dessicate, turn black and constitute 
a large scab, which is exceedingly hard, tough and adherent. 
The number of these necrotic areas is usually limited to from 
two to five or six upon the entire udder and teats. They vary 
in size from or»e-quarter to one-half inch, or even more, in diame- 
ter. Ordinarily the disease pursues a comparatively benign 
course ; but the diseased areas are sensitive and painful, so that 
the cow resists being milked. In some cases the disease is fol- 
lowed by a very destructive streptococcic mammitis, which usu- 
ally leads to the permanent destruction of the affected quarter 



970 Veterhiary Obstetrics 

or quarters. The danger of mammitis increases as the proximity 
of the lesion to the teat orifice increases. Sometimes the lesion 
occurs in the teat orifice itself, interfering promptlj' with the pas- 
•sage of milk and leading quickly, in many cases, to infection of 
the gland. 

Apparently the mammitis is not the direct, but rather an indi- 
rect result of the presence of the eruptions. The infection of the 
gland takes place after the scabs have attained large size and 
more or less abundant suppuration has occurred around their bor- 
ders. It seems that the infection is attributable to the pus 
which thus forms, and later gains access to the milk cistern 
through the teat orifice. Our chief interest in the disease is the ' 
prevention of the mammitis by thorough disinfection. Whether 
this be genuine cow-pox or not, the disinfection should be careful 
and ample. The diseased parts should be thoroughly disinfected 
before and after milking, and the hands of the milkers should be 
well disinfected before and after the milking of each cow, 
whether diseased or sound. We recommend in this disease the 
washing of the udder of the cow and the hands of the milkers 
with a i-iooo corrosive sublimate solution, to be followed by 
the application of a disinfectant to the teats and adjacent parts 
of the udder, consisting of equal parts of tincture of iodine, tinct- 
ure of arnica and glycerine. If the crusts become detached, leav- 
ing a raw sore, this may be carefullj' touched with stick silver 
nitrate, or with tincture of iodine. 

When the lesion is located directly in the milk orifice, vigor- 
ous disinfection should be instituted. The part should be pen- 
cilled with a fine cone of silver nitrate, or a drop of tincture of 
iodine inserted by means of a medicine dropper. 

4. Tuberculosis of the Udder. Tubercular Mammitis. 

Tuberculosis of the udder is virtually confined to the cow. 
Although tuberculosis is very common among dairy cows, recog- 
nizable tubercular disease of the udder is comparatively rare. 
When it does occur it is regarded as especially important because 
of the highly infectious character of the milk. 

Symptoms. The symptoms of tuberculosis of the mammary 
gland consist usually of a tense swelling of the raammse, gener- 
ally of one quarter only, and most frequently one of the hind 
quarters. The general condition of the animal is not affected by 



Tubercular Main?nitis 971 

the tuberculosis of the udder, and whatever constitutional symp- 
toms may appear are referable to the ravages of the disease in 
other parts of the body. The mammitis is chronic in character, 
and increases very gradually in volume and hardness. After a 
time the affected quarter becomes very hard and extremely large. 
Franck records cases in which the udder has attained a weight 
of 30 to 40 pounds. 

The secretions of the gland depart from the normal very gradu- 
ally, and may retain the general appearance of milk for weeks 
or months, and then slowly become watery, filled with clots and 
perhaps becomes yellowish in color. The Ij'mpli glands on the 
proximal side of the mammae, the supra-mammary lymph glands, 
become swollen to such a degree that they may be felt or seen. 

The diagnosis of tubercular mammitis is to be made in con- 
junction with the general symptoms. The definite diagnosis 
must depend largely upon the tuberculin test. According to 
Baug the disease is characterized by the fact that, for some time 
after the advent of the malady, the secretions of the gland remain 
apparently normal in appearance and quantity, although in some 
cases the disease may be acute from the beginning, and conse- 
quently the amount of milk very much decreased. In compari- 
son with other forms of mammitis, it is important to note that 
as a rule there is little or no pain in the tubercular portion of the 
udder. 

Tuberculosis of the udder occurs chiefly in very severe cases 
of tuberculosis. The course is comparatively rapid, and the animal 
may succumb to general tuberculosis in a few months. 

Upon post-mortem examination the swelling of the affected 
glands is usually diffuse, though in some cases it is nodular. 
Upon section, the swollen parts of the udder are found very firm, 
and the cut surface is even, while the affected portions are 
prominently separated from the sound parts by a clear line of de- 
marcation. There occur, throughout the diseased portion of the 
gland, more or less numerous j^ellow spots or tubercules, while 
the larger milk canals may contain yellowish caseous masses 
and the walls of the milk cisterns may show small tubercular 
elevations. 

In cases of long standing, the tubercular degeneration of the 
gland becomes more evident, and the tubercles may become 



972 Veterinary Obstetrics 

widely disseminated through the glandular tissue without causing 
a very dense swelling. 

Microscopic examination of the caseous masses, the miliary 
tubercles, and the milk from the tuberculous udder, reveals an 
abundance of tubercle bacili. 

The feeding of such milk has produced tuberculosis in swine, 
rabbits, cows, cats, goats and other animals, and numerous in- 
stances are cited where fatal tuberculosis of man has apparently 
resulted from the ingestion of such milk, especially by children. 
Tuberculosis of the udder is incurable. 

5. Actinomycosis of the Udder. 

Actinomycosis of the udder may occur in any animal which is 
subject to actinomycotic infection, but has been observed 
chiefl3' or whoUj' in the cow and sow. It closely resembles in 
many respects tuberculosis of the udder. Prior to the identifica- 
tion of actinomycosis, the disease was usually mistaken for 
tuberculosis. It may affect one or all quarters, but has a 
great tendency to remain confined to one quarter, because as a 
general rule, the source of the infection is local and not systemic ; 
whereas the opposite usually holds true in cases of tuberculosis. 

The maladjr usuallj^ reveals itself in the form of a chronic, 
slow-forming nodular disease of the gland, the nodules varying 
from ^ to 4 inches or more in size, and consisting of small abscesses 
surrounded by thick and dense connective tissue. These small 
foci behave like actinomycotic abscesses occurring in other tissues 
of the body ; they tend to rupture one after another, and leave 
small fistulous openings, which are somewhat retracted, and heal 
tardily. 

Upon section, the actinomycotic lesions have the superfi- 
cial appearance of tuberculosis, and may at first be mistaken for 
that disease. The section reveals abscesses of various sizes, sur- 
rounded by more or less dense connective tissue walls. If the 
abscess is large, and contains much pus, the wall is usually very 
thick and dense. If the abscesses are very small, or consist 
of very small suppurating areas, the walls are not so conspicuous, 
and the tissues invaded by the disease present a yellowish, gran- 
ular appearance, quite characteristic of the malady, and different 
from that of tuberculosis. In actinomycosis, caseation and calci- 
fication do not occur. The diagnosis may be definitely made by 



Mastitis in the Mare 973 

the microscopical examination and the identification of the acti- 
nomyces. 

The handhng of the disease does not differ from the treatment 
of actinomycosis in other parts of the body. It depends essen- 
tially upon the internal administration of iodine, or the direct 
surgical removal or destruction of the diseased parts. Internally 
potassium iodide may be administered to the cow, in doses of i 
to 3 drams per day, while tincture of iodine or iodine ointment 
may be locally applied to the udder. In other cases it is best to 
extirpate the affected part completely with the scalpel. When 
large abscesses appear, they may be sloughed out by opening them 
and then filling the cavity with sulphate of copper crystals, and 
leaving them in position until they come away spontaneously. 

6. Mastitis in the Mare. 

Acute mastitis due to ordinary infection of the udder is rare in 
the mare. It is occasionally observed at about the time of foal- 
ing, or within a few days thereafter, and may run a similar course 
to the disease in the cow, though not usually so violent. 

Abscesses occur somewhat rarely, but are largely referable to 
other causes than ordinary wound infection, chiefly to strangles 
and botryomycosis. As in the cow, it is possible for the inflam- 
mation to pursue a chronic course. The prognosis in mammitis 
of the mare is more favorable than in the cow. The handling of 
the disease in the mare calls for nothing different from that in 
the cow. 

7. Mammary Strangles in the Mare. 

When strangles attacks a mare which is nursiiig a young foal, 
the infection is very liable to involve the milk glands and cause 
abscesses of these or of the neighboring lymph glands. The ab- 
scesses are frequently very large, and are accompanied by exten- 
sive and virulent inflammation of the gland. The abscess may 
rupture externally, and escape over the side of the udder, or it 
may rupture within and escape through the teat with the milk. 

An abscess of the mammary gland, due to strangles, does not 
vary in any essential particular from a strangles abscess in any 
other portion of the body, but may at first be mistaken by the 
practitioner for an ordinary case of mammitis. Generally, how- 
ever, the abscess of the udder follows the formation of abscesses 



974 Veterinary Obstetrics 

in the sub-maxillary glands or elsewhere, so that the practitioner 
is forewarned as to the character of the disease. 

The chief significance of strangles abscess in the mammary 
gland of the mare is in relation to the health of the foal. In our 
experience, when a young foal takes milk from a mare which is 
suffering from strangles, and especially when the strangles affects 
the udder itself in the form of abscesses, the malady has an 
unusual virulence for the foal, and it is very liable to perish. 

The handling of strangles of the mammary gland demands 
the same general measures as in other cases of strangles, in so far 
as the mare is concerned. The abscesses should be opened early, 
and the animal should receive internally reliable antiseptics, 
especially large doses of potassium iodide, in order to overcome 
the infection as early as possible. 

The foal should be removed from the mare, and fed upon milk 
from a healthy mare or from a cow, and should receive some 
preventive treatment, such as the administration of potassium 
iodide in its milk, in order if possible to decrease the severity of 
the attack, which must almost inevitably occur. 

8. BOTRYOMYCOSIS OF THE UDDER. 

There occurs occasionally in the mare a chronic, indurative 
inflammation of the milk gland, which is characterized by a very 
tense and hard enlargement of the udder, with chronic fistulae 
and small recurrent abscesses. It is claimed to be due to a 
special form of micro-organism, known as the botryomyces equi 
or micrococcus ascoformans. Some pathologists claim that this 
micro-organism is simply one of the pus-forming organisms, and 
that the peculiar characters of disease resulting from it, the new 
formation of sclerotic connective tissue, the formation of abscess 
and fistula are due, not to the special form of the agent causing 
it, but to the peculiarities of the tissues of the animal itself. 
The general character of botryomycosis of the udder of the mare 
is analogous in all respects to that of botryomycosis of other tis- 
sues and organs of the horse. 

Symptoms. The symptoms of botryomycosis of the udder in 
the mare are generally well developed before they attract any at- 
tention. The disease may occur in an animal which is nursing a 
foal, or in one which has been dry for months or years, or possibly 
has never bred. It is usually first observed by the owner when the 



Botryomycosis of the Udder 975 

gland becomes much swollen because of the maturing of an ab- 
scess preparatory to its rupture. The gland may become so 
swollen, tense, and sensitive that the animal shows pain, ex- 
pressed by lameness in the hind limb of the corresponding side. 

There is usually some edema in the subcutaneous tissues of the 
udder and neighboring parts. As a rule, but one-half of the 
gland is involved. After a few days the matured abscess ruptures 
and discharges a small quantity of pus, and there remains for a 
period of time an inconspicuous fistulous opening, from which a 
verj' small quantity of pus exudes. The mouth of the fistula 
sinks deeply into the skin by retraction of its scar tissue. If a 
probe be inserted into the fistula, the canal is found tortuous, but 
one maj' be able to follow it for a distance of two to six or more 
inches. After a time the fistula heals, and later another small 
abscess forms in some other portion of the gland, and ruptures, 
to be followed b}' another fistulous opening. In some cases there 
may exist, at one time, two, three or more fistulous openings, 
from each of which a very small quantity of thick pus is dis- 
charged. 

The general health of the patient is not apparently afi^ected. 
The, diseased gland continues to grow, and may attain a very 
large size. 

The disease is chronic, and shows no tendency toward spon- 
taneous recovery, but rather continues from year to year. 
There is little tendency for the disease to pass beyond the capsule 
of the gland and involve neighboring tissues. Vennerholm states 
that it may extend to the thigh or perineum, and may thus cause 
marasmus and the death of the animal. 

The differential diagnosis sometimes offers difiiculties. A gray 
mare, entered in our clinic, presented symptoms which made it 
difficult to determine whether she was suffering from botryomy- 
cosis, melanosis or a malignant new-growth. The affected half 
of the gland was enormously enlarged, and the animal showed a 
distinct cachexia and was very stiff in her movements. Explor- 
ing the pelvic cavity and posterior portion of the abdomen per 
rectum, we found that the growth extended up through the in- 
guinal ring into the peritoneal cavity. An unfavorable prognosis 
was given, and the animal was destroyed, whereupon it was 
found that the gland was invaded by a malignant melanom, and 



976 Veterinary Obstetrics 

the liver weighed 72 pounds, it being likewise the seat of 
malignant melanosis. 

Generally the disease is easily diagnosed by the chronic course, 
the enlarged sclerotic gland, and the small abscesses and fistulse. 

The handling of the disease consists essentially of the early 
amputation of the gland, by the method which we have already 
described for amputating the udder of the cow. Asinbotryomy- 
cosis of other parts of the bodj', so here we may cause improve- 
ment of the disease by the internal administration of iodide of 
potash. In our experience, however, we have never succeeded 
in bringing about the cure of botryomycosis, in any organ, by 
means of this drug. 

9. Infectious Gangrenous Mammitis of Ewes. 

Pustular Eruptions of the Eips of Nursing Lambs. 

We observed in our clinic an important outbreak of gangrenous 
mammitis in ewes, which proved uniformly fatal. The 
mammary affection began ver}' suddenly, with intense inflamma- 
tion, engorgement and redness of one- half of the udder. The 
patient at once became very lame, much depressed, with loss of 
appetite and cessation of rumination. Within 24 to 48 hours 
after the advent of the attack, the apex of the nipple of the af- 
fected gland assumed a dark necrotic-black color, the teat was cold 
and its epithelium was easily detached and rubbed off. Paralysis 
and death rapidly followed. 

Searching for the source of the infection, we discovered 
that most of the lambs in the flock were affected with pustular 
eruptions of the lips. The pustules were located chiefly upon 
the labial margins, were about Vi, in. high, sharply conical and 
filled with yellow pus. Breaking, they left behind slow-healing 
ulcers. 

Apparently the disease of the lips of the lambs, and the gan- 
grene of the mammas of the ewes, were identical, and the nursing 
served to transmit the infection to the udders of the ewes and 
vice versa. Thorough disinfection of the lips of the lambs, with 
penciling of the labial ulcers with silver nitrate, was followed by 
a cessation of the mammitis in the ewes. 



hifectious Agalactia m Goats and Sheep 977 

10. Infectious Agalactia in Goats and Sheep. 

There has beeu observed from time to time, in Italy, Switzer- 
land and France, an infectious disease of the mammary glands 
of sheep and goats, characterized chiefly by a gradual decrease 
in the volume of milk and an extreme atrophy of the glands. 

Clinically the disease presents all the characteristics of an in- 
fection which is readily transmitted from animal to animal, and 
involves not onlj' the infection of the mammary glands, but also 
the articulations, the tendon sheaths and the eyes. Vennerholm 
mentions one herd of 28 animals, in which, during the course of 
six weeks, 24, including one buck and one kid, showed symptoms 
of the disease. The male animals suffered from the disease of 
the eyes and articulations. 

The malady does not seriously affect the general well-being of 
the animal. The milk becomes greatly changed, is grayish-white 
and flocculent, and after standing there appears a precipitate of 
pus, which is separated from the normal milk by a sharp line of 
red, due to the presence of red blood cells, The milk acquires a 
bitter, saline taste ; while the reaction is variable, sometimes 
feebly acid and sometimes alkaline. In very severe cases the milk 
may be firmly coagulated and opaque. The quantity of milk 
may be decrea.sed rapidly, to the extent of 90 to 95%. 

As in the agalactia of the cow, so in the disease of the 
sheep and goat, there are no marked evidences of acute inflam- 
matory changes, as exhibited by swellings or tenderness in the 
gland. The gland tends rather to become atrophied, and finally 
retracts to one-tenth of its original volume and becomes ver}' in- 
conspicuous. Later in the course of the disease, without any 
evidence of pain, there may appear abscesses of a chronic or 
" cold " character in the udder, as well as in the parotid salivary 
glands and in the region of the stifle. These abscesses contain 
a thick yellow pus. In a manner somewhat similar to the forma- 
tion of metastatic abscesses, there also appear inflammations of 
the fetlock, stifle, hip, carpus and elbow, which in some instances 
constitute the only evidence of the disease, especially in males or 
in females which are not in milk. Tendo-vaginitis may also 
appear. 

In a large proportion of cases there appears a well-marked 
62 



978 Veterinary Obstetrics 

keratitis, in which there is either a local or a diffuse cloudiness 
and ulceration of the cornea, with increased vascularity and 
hemorrhages. In some cases staphyloma, followed by rupture of 
the cornea and hernia of the iris, has occurred. The disease of 
the eyes continues for a prolonged period, and generally ends in 
recovery in from six to eight weeks, though white or pigmented 
spots sometimes remain upon the cornea. These changes in the 
cornea are accompanied by conjunctivitis. 

As a general rule the animals recover, and finally their power 
of milk production becomes restored. The cause of the disease 
has not been determined, and attempts to transmit it from one 
animal to another have failed. Isolation and disinfection are 
apparently indicated. 

II. Mammitis in Swine. 

Inflammation of the mammae in swine is an exceedingly rare 
disease. It may involve one or several of the glands, and present 
the ordinary symptoms of mastitis, with swelling, pain and a 
general depression of the system. The inflammation may end in 
resolution, induration or gangrene, and in the latter case may 
result in the death of the animal. The sow is so immune to 
ordinarj- wound infection that it is only under very great provo- 
cation that the glands become inflamed. The handling is accord- 
ing to the general rules already related for mastitis in the cow. 
12. Mammitis in the Bitch. 

According to Vennerholm, mammitis is very common in the 
bitch, when her puppies have been prematurely taken away. 
As in the sow, so in the bitch, there is a high degree of immunity 
against invasion by the ordinary organisms of wound infection, 
except under peculiarly favorable conditions. In the bitch, as 
in other multiparous animals, inflammation of those glands which 
are not used is not usually observed. Ordinarily the number of 
glands exceeds that of the young, each of which has its own teat, 
from which it obtains its milk supply. Any extra glands which 
the mother may have are allowed to atrophy, and cease to func- 
tion from the first, without apparently causing any marked de- 
gree of discomfort or danger ; but, after a gland has been fully 
aroused to its function because of its use by the new-born animal, 
if the young is removed before the normal decline in lactation, 
mastitis is probable. 



Edema of the Udder 979 

The symptoms of mastitis in the bitch are peculiar chiefly in 
the fact that the milk canals are swollen and distended, so that 
they feel like stretched cords. As no milk cistern is present, 
the mammitis tends to become lobular, being confined to the 
lobule of the milk canal into which the infection has penetrated. 
Otherwise the swelling does not differ materially from mastitis 
observed in other animals. The character of the milk is changed, 
becoming serous or purulent, and mixed with blood. The in- 
flamed gland is not especially painful. More or less edema may 
be present, in the early stages. The course of the disease is not 
so acute as that observed in ruminants, but tends rather to be- 
come chronic and to result in induration and atresia of the milk 
canals. These changes in general take the character of adeno- 
fibroma. 

In some rare instances the glands become rapidly gangrenous, 
but as a general rule this does not cause the death of the animal. 

The handling of the disease is essentially the same as in other 
animals, and consists of repeated massage and milking out, with 
the application of an antiseptic poultice. Later, if the disease 
becomes chronic, or should gangrene occur, the affected gland or 
glands. may be amputated. 

13. Edema of the Udder. Mammary Engorgement. 

Clinically there not infrequently occurs edema of the udder, 
which may be of a more or less physiologic character and may 
consist largely of engorgement of the gland without the advent 
of inflammation. 

It may appear either during pregnancy or early after parturi- 
tion. In some instances, during pregnancy, the occurrence of 
engorgement and edema of the mammary glands may suggest 
the death, or some disease orMisturbance of the fetus. Very fre- 
quently the symptoms are followed by abortion. Toward the 
culmination of pregnancy, the mammary glands become more or 
less congested, depending somewhat upon the species and indi- 
vidual. As a general rule, the congestion and edema are most 
marked in animals which have not previously given birth to 
young. 

The symptoms in such cases apparently rest upon a physio- 
logic basis, depending upon the harmonious functioning of the 
uterus and the mammary glands. In some animals, especially in 



980 Veterittary Obstetrics 

the bitch, edema of the mammae may occur at about the normal 
time for parturition, after the disappearance of estrum without 
impregnation. In these instances it seems that the functional 
activity of the glands becomes aroused without pregnancy having 
taken place at all, as the result of some organic sympathy be- 
tween the two parts of the generative system. 

We have also observed such edema of the udder, in the non- 
pregnant mare mule, accompanied later by the active secretion 
of milk. In these cases the edema was related to the functional 
activity of the uterus and ovaries, and occurred during the breed- 
ing season only. 

In the cow, when for any reason the milk canals or the teats 
become blocked so that the milk cannot escape, there occurs a 
great distension of the gland, by the accumulation of milk within 
its canals, until the pressure within its cavity attains such a de- 
gree that the further secretion of milk is stopped. This condi- 
tion of over-distension brings about an edema of the gland, 
accompanied by retrograde changes in the milk and its final 
resorption, followed by atrophy of the gland. 

When the young is removed from the mother while lactation 
is still active, a similar edema results because of the over-disten- 
sion of the gland. This very frequently leads to infection, be- 
cause the orifice to the teat is open, which permits the invasion 
of micro-organisms. Should the gland escape infection, the 
changes taking place pursue the same course as in those instances 
where the teat orifice is blocked and infection prevented. 

The symptoms consist essentially of a gradually increasing 
tension of the gland, which may be more or less painful and may 
involve a quarter or half or the entire gland, while the edema 
may extend forward anterior to the mammse, or upward and 
backward to the region of the perineum. 

The temperature is little or not at all elevated, and the secre- 
tions from the gland are not materially altered from the normal. 

The anatomical conditions, in cases of edema or congestion of 
the udder, consist essentially of vascular engorgement and con- 
gestion of the inter-glandular connective tissue. Unless the 
edema leads to infection, the disease pursues a favorable course 
and ends in spontaneous recovery after a few days. Especially 
is this true of the engorgement of the gland just prior to 
parturition. 



Tumors of the Mani77ice 981 

It is not essential, usually, that any active handling occur. 
As soon as lactation has become well established and the young 
sucks regularly, or the gland is well milked out, the edema spon- 
taneously disappears. If, however, the young dies or has been 
removed, and it is not desired to keep up the lactation for the 
production of milk, it is advisable and frequently essential that 
a portion of the milk should be withdrawn two or three times a 
day, until the activitj' of the gland becomes diminished. If 
less and less of the milk is withdrawn each day, the lactation 
gradually ceases, and the milking may be discontinued gener- 
ally within five or six days. Most domestic animals are thus 
easily dried up, though in some instances there is considerable 
difficulty, especially in the milk cow. In some of the best dairy 
animals it is almost impossible to stop the secretion of milk with- 
out endangering the integrity of the gland. This difficulty is 
also observed at times in ewes, when weaning lambs, espe- 
cially if they are weaned somewhat early, before the milk glands 
have largelj' ceased their functions. In some of the larger breeds 
of sheep, which are very heavy milkers, it is well to carefully 
watch the ewes while the lambs are being weaned, and withdraw 
part of the milk from those which show very great distension 
of the gland with the consequent edema. 

14. Tumors of the Mamm^. 

Tumors of the mammary glands are very rare in domestic 
animals, with the exception of the bitch, in which the}' are com- 
mon. Ruminants are almost wholly free from any form of mam- 
mary tumor. In the mare we observe chiefly the botr3'omycotic 
udder, which has already been described upon page 974, and 
belongs distinctly to infections, not to tumors proper. The 
bitch suffers occasionally from a form of granulation tumor or 
adeno-fibrom, in which the general characters of adenoma and 
fibroma are combined. Such adeno-fibroma are usuallj- the 
sequel of infection. 

The adeno-fibrom consists chiefly of an increase of the con- 
nective tissue between the lobules of the gland, which new-formed 
tissues press upon the acini and gradually bring about their de- 
struction, until there remains simply the epithelial debris sur- 
rounded by firm connective tissue. 



982 Veterinary Obstetrics 

Malignant neoplasms of the mammae are very common in the 
bitch, and exceedingly rare in other domestic animals. In aged 
bitches mammary carcinoma are very common. They assume 
various types, most frequently scirrhous, more rarely myxoma- 
tous, and in some rare cases are accompanied by calcification or 
ossification. The cancer may break down and result in ulcera- 
tion, or the blood vessels may become eroded and cause a hematom. 
The carcinoma usually originate in the substance of the gland, 
although more rarely they may have their beginning in the skin 
covering it. As a general rule the development of the tumor is 
slow, although it may at times be rapid. In some instances the 
tumors remain quiescent for a long period of time, especially if 
not interfered with ; while in other cases, especially if the glands 
have been removed, metastatic tumors occur in the surrounding 
tissues, which pursue a very rapid and virulent course. 

In carcinoma of the mammae of the bitch, the affected gland 
or glands are enlarged and hardened. The swelling is distinctly 
lobular, and usually commences near the base of the teat, extend- 
ing thence upward to involve the entire gland. Sometimes the 
disease is confined to a single gland, but frequently it involves 
several, and in some cases virtually all of the glands, one after 
another. The extension from one gland to another may be very 
rapid. 

Sarcoma of the milk glands occur chiefly in the bitch and 
mare, as nodular and more or less soft swellings, which may reach 
very large proportions. In the mare the tumor may extend up- 
ward from the gland through the inguinal canal into the peritoneal 
cavity. 

As in the adeno-fibrom and the carcinom, so in sarcoma, there 
may be a tendency to ossification, or cysts may form containing 
a variable quantity of fluid, which ma)' resemble mucus, and con- 
tain detritis of cells, along with fat and crystals of cholesterine. 

Other tumors of the mammary glands, such as chondroma, 
lipoma and osteoma, occur in domestic animals, especially in the 
bitch. Very rarely large cystic tumors form in the mammae, 
filled with a mucoid substance, while their boundaries may be cal- 
cified and .sharply limited so that they can be easily enucleated. 

Rehmet relates the occurrence of echinococcus polymorphus in 
the udder of a cow. Numerous large firm nodules were observed, 
which were suspected of being tubercular in character ; but. 



He^norrhages in the Udder 983 

when examined after slaughter, were found to consist of very 
tense C3'sts, varying in size from a hazelnut to a hen's egg, and 
containing a clear fluid and echinococci. 

There are also observed, in the udder, retention cysts. A milk 
canal leading from a portion of the gland becomes occluded, and 
consequently a quantity of milk is imprisoned until it causes a 
sufficient distension that it is readily seen and felt. It presents 
the characters of a fluctuating tumor, and, when opened, dis- 
charges ordinary milk. 

The handling of tumors of the udder consists essentially of 
their early enucleation, or the amputation of the entire gland. 
It is especially important, when malignancy is suspected, that 
the entire gland should be removed early, and along with it 
should be included any neighboring lymph glands which are prob- 
ably or possibly involved. If the malignant tumor has existed 
for a long period of time, the probabilities are that its removal 
will but excite other disease foci in neighboring glands to in- 
creased activity, and that the disease will run a more virulent 
course than if left untouched. 

15. Hemorrhages in the Udder. 

Hemorrhages ma^' occur in any part of the udder, either be- 
cause of trauma or exalted blood pressure, and may result in the 
formation of hematoma ; or the blood may flow into the larger 
milk canals or milk cistern and be milked out. 

The symptoms necessarily vary greatly according to the loca- 
tion of the injury and volume of blood escaping from the vessels. 
A large volume of blood causes a distinct .swelling of the udder. 
This is especially notable if a hematom occurs in the subcutaneous 
connective tissue. In pendulous udders the gland is constantly 
turned to and fro upon its long axis, during the progression of 
the animal, because at each step it strikes against the advancing 
hind limb, or it comes in violent contact with obstacles in the 
path of the animal, from either of which causes the udder may 
receive more or less serious injuries. In the normal gland, in- 
jury may result from rough milking, from treads or other- 
wise. 

The milk from an animal suffering from mammary hemor- 
rhage ma}' be mixed with blood, or pure blood may be drawn 
from the teat. If the hemorrhage is very extensive, the udder 



984 Veterinary Obstetrics 

may hang very low because of the great weight of the large 
hematom which it contains. If an injury has caused hemorrhage 
into the udder, and the blood becomes mixed with the milk, the 
mixture is usually somewhat clotted. When mammary hemor- 
rhage is due to the passage of red corpuscles through the walls 
of the capillaries into the milk vessels, the blood is uniformly 
mixed with the milk, and may give it a reddish tinge, or may 
pass unobserved until the milk has stood for a time, when the 
blood, on account of its weight, sinks to the bottom and is very 
readily seen. 

The advent of blood in milk not infrequently indicates the 
commencement of a chronic catarrhal mammitis, affecting chiefly 
the milk cistern and large canals. The bloody character of the 
milk may presently abate, but the catarrh persists, leading grad- 
ually to atresia of the teat. The atresia may mature dur- 
ing the milking period, or its completion be delayed until the 
dry period, and when the cow again comes into milk the atresia 
may be found complete. 

Special forms of infection sometimes cau,se a reddish tint of the 
milk, in the absence of blood or blood-coloring matter. 

Termination. In those cases of bloody milk due to exalted 
blood pressure in the gland, the duration of the condition is 
usually prolonged, so that it is a long time before the milk again 
becomes normal. As a general rule the result is very unfa- 
vorable, because the same condition tends to recur at each 
calving. If hematoma form, they are slowly resorbed, to leave 
cysts behind, or induration of the gland occurs, or the wall of the 
hematom gives way and its contents escape externally. Should 
the hematom become infected, mastitis results, usualh^ followed 
by abscess. 

When a limited amount of hemorrhage occurs in the milk, the 
most that can be done is the careful milking out. This does not 
prove very satisfactory, as the milk is unfit for use, and the 
animal tends to give bloody milk again and again at the begin- 
ning of each milking. When hematoma form, an attempt may 
be made to check the hemorrhage, if still existing, by the appli- 
cation of cold, especially of ice by means of a suspensory bandage, 
or by hemostatics given internally. Generally this is not neces- 
sary. The hematom should be left alone for two or three days, 
until assured that the hemorrhage will not be renewed and that 



Milk Fistula; 985 

a somewhat resistant wall is formed around the escaped blood. 
The hematom may then be opened and the blood removed, after 
which the lesion is to be handled as an ordinary wound. 

16. Milk Fistula. 

A milk fistula consists of a communication of the milk cistern or 
one of the large milk canals with the exterior, through a canal 
other than the normal one. While such fistulse are possible in 
any animal, they occur, or are observed, practically in the cow 
alone. Their very rare occurrence in other animals is of little or 
no significance. The fi.stulEe may be congenital, but generally 
they are caused by penetrating wounds of the milk cistern during 
the period of lactation. They arise from trauma of various 
kinds, and in some instances result from operative w'ounds, or 
from abscesses forming in the milk cistern or large milk sinuses 
and rupturing outward through the wall of the teat or udder. 

Symptoms. Milk fistulse may open at any part of the teat, 
or of the udder near the teat base. They are most common in 
the teat near its base, though sometimes observed at the apex of 
the teat, within a very short distance of the normal opening. If 
the fistulous opening is very small, the milk may not flow from 
it except when the teat is being milked and greater pressure is 
consequently placed upon the fluid within the cistern. If the 
fistulous opening is large, the milk drops away continually when- 
ever the pressure of the milk in the cistern is sufficiently high. 

Fistulse of the milk canals tend to heal spontaneously in a com- 
paratively short time, while those of the milk cistern, and espe- 
cially tho.se of large size, do not readily heal of themselves, and 
are liable to become permanent unless active intervention occurs. 
If the fistula forms somewhat early, during active lactation, its 
walls tend to become healed and covered over by a protective 
epithelium, so that they will not readily adhere. If the perfo- 
rating wound occurs while the cow is dry, or if she ceases to milk 
before the walls of the fistula become covered over with epithe- 
lium, adhesion of the wound margins, with spontaneous oblitera- 
tion of the fistula, is probable. 

Treatment. Perforating wounds of the milk cistern or canal 
should be handled as soon as possible after their occurrence. The 
handling should consist essentially of the thorough and careful 
disinfection of the wound, after which it may be neatly sutured 



986 Veterinary Obstetrics 

and measures taken to protect the sutures during milking. It 
is highly important that strict antiseptic rules should be followed 
in order to prevent infection of the gland. It has been sugges- 
ted that the danger of disturbing the sutures, should be overcome 
by the use of the milk tube, under very strict antiseptic precautions. 
Vennerholm advises that a rubber band may be placed over the 
suture to afford pressure, being careful not to apply it so tightly 
as to cause a disturbance of the circulation. One may do much 
also to prevent the tearing out of sutures, or even to overcome 
the necessity for their insertion, by applying a strip of adhesive 
plaster carefully to the part. The strip should be long and nar- 
row, and applied by encircling the teat several times, each course 
overlapping the preceding one, the whole forming a solid encase- 
ment, insuring the accurate and secure closure of the wound. 

In chronic fistula, in which the walls are covered over with ep- 
ithelium, it is essential that the protective epithelial layer be 
destroyed before adhesion can take place. The epithelium of 
the fistula may be most readily destroyed with a fine thermocau- 
tery point, by inserting it well into the fistulous tract and con- 
tinuing the cautery until the epithelium has been completely 
destroyed. In place of the thermocautery one may use a caustic, 
especially the nitrate of silver. If the fistula is at the apex of 
the teat and near by the normal opening, it may sometimes be 
best handled by the amputation of the teat just above the fistula. 

It is usually desirable that any interference with chronic milk 
fistula should be deferred until the cow is dry, in order to avoid 
as far as possible the danger of infection of the gland as a result 
of the injuries to the tissues during the operation. 

Supernumerary teats sometimes exist in a manner to con- 
stitute an annoyance in milking, because they are constantly in 
the way of the milker. Sometimes they act as fistulse, through 
which milk escapes while the milking process is going on with 
the normal teats. Should they prove annoying, it is best to 
amputate them during the dry period, when the healing of the 
wound will usually cause an obliteration of the duct or cistern of 
the supernumerary "nipple. 

When heifer calves are born with supernumerary teats, which 
may later prove annoying or unsightly, they may readily be re- 
moved by clipping them off with scissors. The teat should be 
well drawn out, and excised close against the gland. In healing, 



Milk Stones or Milk Calculi 987 

any milk orifice traversing it will be closed and, if clipped closely, 
will not show when the animal is grown. When the heifer 
calves, the rudimentary gland may function temporarily, but 
soon ceases to secrete because of the pressure of the confined 
milk. Later the gland atrophies. 

There is a want of power in the teats of some cows to retain 
the milk within the udder, so that as soon as the gland becomes 
distended, the milk begins to escape involuntarily through the 
teat canal. This causes great waste by allowing a large propor- 
tion of the milk secreted to escape from the teats during the in- 
terval between milkings. Various plans for overcoming the 
difficult}' have been suggested and tried, but none of them are 
very satisfactory. The cow may be milked very frequently, so 
as to prevent any great pressure of the fluid within the gland ; 
or the lumen of the teat canal may be closed by the application 
of a rubber band or a metal ring. 

Vennerholm suggests the possibility of bringing about a nar- 
rowing of the teat canal by the excision of a wedge-shaped piece 
of the teat wall, in the hope that, in healing, the teat orifice may 
contract sufficiently to hold the milk. He admits, however, that 
it is exceedingly difiicult to determine the proper amount of tissue 
to remove. If too much is included, the teat canal may become 
obliterated or excessively narrowed ; if too little is taken, the 
object is unaccomplished. Amputation of the apex of the teat 
may also cause narrowing, but the degree can not be foretold. 

17, Milk Stones or Milk Calculi. 

There are occasionally found, in the udder of the cow, con- 
cretions of the carbonate of lime, mixed with small proportions 
of fat or casein, and varying in size from that of a mustard seed 
to a large bean. They may occur singly or in large numbers. 

When very large they may readily be felt through the walls of 
the large milk canals or of the cistern, and may become lodged in 
the teat canal in such a manner as to interfere with the flow of 
milk, and cause pain to the animal during milking. When 
occurring in large numbers, they may cause a general sensitive- 
ness of the gland, accompanied by some stiffness and a 
straddling gait. 

They are to be differentiated from nodular enlargements in the 
teats. The latter are immoveable and grow slowly, while the 



988 Veterinary Obstetrics 

calculi are generally movable, at least during their early stages 
or until they accidently become incarcerated in the teat canal. 

Sometimes milk stones may be forced out through the teat 
canal without injury, but if too large for this to be accomplished, 
it is advisable to remove them by means of an incision through 
the walls of the gland, after which the wound should be 
carefully closed immediately. 

1 8. Pendulous Udder. 

The mammae of the cow, ewe and goat frequently become very 
pendulous, and hang down almost or quite to the ground. Such 
an udder is in constant danger of injury from being struck by 
the hind legs during locomotion, especially when the animal is 
forced to run. It may also come in violent contact with ob- 
stacles of various kinds in a manner to cause wounds, to be 
followed by infection. 

Sometimes a pendulous udder apparently results from a gradual 
yielding of the suspensory apparatus of a comparatively normal 
gland. Once the gland drops away from the abdomen for a short 
distance, its weight tends to cause it to drop lower until the 
pendulousness becomes extreme. In other cases the pendulous- 
ness is attributable to mammitis, followed by induration and 
enlargement, the increased weight overcoming the power of the 
suspensory apparatus and causing the gland to drop down 
away from the abdomen. 

We have no successful method for overcoming the pendulous 
udder. An ordinary animal so affected should be fitted for the 
butcher. In a pedigreed cow having a very high value as a breeder, 
if the udder is much enlarged and indurated, is so pendulous as 
to constitute a constant and serious impediment to locomotion, or 
menace the health or life of the animal on account of repeated 
infections from injuries, the pendulous organ should be 
amputated according to the technic already suggested on page 963. 

19. Dermatitis of the Udder. 

Inflammation of the .skin of the udder is said to be caused at 
times from exposure to the rays of the sun in hot weather. The 
effect is referable, according to Vidmark, to the action of the 
ultra-violet rays upon the non-pigmented skin, which leads to 
dermatitis and mummification. 



Dermatitis of the Udder 989 

When cows are exposed to cold and damp winds, the skin of 
the teats and udder is liable to become inflamed and cracked. If 
the teats of the cow are bathed or moistened, preparatory to 
milking, and then left to dry in a cold draft, the skin is liable to 
crack and become very sore, so that in milking it bleeds and 
causes quite severe pain to the animal, which not infrequently 
leads to uneasiness and kicking. 

Dry gangrene of the skin of the teats is said to result in some 
cases from the feeding of cows upon potato refuse or ergotized 
fodder. Wounds or other injuries to the teat or glands may 
likewise cause dry gangrene. 

The symptoms of dermatitis of the udder are as variable as 
the causes which may induce it. There may be redness accom- 
panied by sensitiveness in the part, or there may be small fissures 
or excoriations from which blood exudes. When gangrene occurs 
there is swelling of the parts, a black or blue-black color, with 
usually a well defined line of demarcation. The sequestration of 
the mummified portion is usually very slow. 

In the Mississippi Valley and some other portions of the United 
States, there appears from time to time, usually in the late sum- 
mer or autumn, a disease affecting the feet, mouths and udders 
of cattle, which was at first mistaken by some for the contagious 
foot and mouth disease. It occurs almost, if not entirely, among 
animals which are upon the pasture. The disease first expresises 
itself by a stiffness in the gait, as a result of the sore feet ; and 
a dribbling of saliva from the mouth, as a consequence of the 
necrosis of the buccal mucous membrane. Hemorrhagic areas 
occur in the skin of the feet, especially between the claws ; upon 
the teats and udder of milk cows ; and in the mucous membrane 
of the mouth, especially upon the bars and pad of the upper jaw. 
Later the areas become necrotic and slough away, leaving painful 
ulcers, which heal in the course of a few days. Upon post- 
mortem examination, in fatal cases, hemorrhagic areas are found 
throughout the length of the alimentary canal. 

The character of the disease is not well known, though it has 
been described by Mohler as mycotic stomatitis. So far as we 
know, the disease of the udder has not proven annoying in any 
case, and simply constitutes an interesting symptom in the course 
of the more widelj- diffused disease. It calls for no special treat- 
ment, so far as observed. 



990 Veterinary Obstetrics 

The prognosis is favorable, except for the danger of infection 
of theglandular tissue itself, leading to mastitis and a disturbance 
of the milk-secreting functions. 

The handling of dermatitis of the udder should be specially de- 
termined for each case, according to the cause. Generally the 
treatment should consist of the application of antiseptics and 
protectives to the injured skin. When the teats are fissured 
and excoriated as a result of exposure to damp winds, or of 
wetting the teats during milking and not properly drying them, 
great care should be taken to thoroughly cleanse them with a 
warm antiseptic solution. Immediately afterward a protective 
antiseptic dressing should be applied. One will usually obtain 
excellent results by first cleansing the parts with warm antiseptic 
solution and then applying, after the completion of the milking, 
a mixture of one part each of tincture of iodine, glj'cerine, and 
tincture of arnica. Such a mixture should be sparingly applied, 
so as to constitute a thin coating over the part. Care should 
be taken to not apply so much as to make the parts sticky, and 
thereby cause dirt to adhere. Vennerholm suggests the applica- 
tion of a salve, consisting of tannic acid and oxide of lead, or 
other similar substances, but such applications cause dirt to 
adhere and keep the teat soiled, unless applied very sparingly. 

If gangrene of the skin is threatened, antiseptics should be 
applied more liberall}', and it is suggested by some writers that 
the skin should be scarified, antiseptic poultices applied, and the 
udder supported by a bandage. 

If the gangrene extends into the deeper parts of the teat, it 
may be advisable to amputate it in order to hasten recovery. If 
the gangrene extends into the cistern, the glandular tissue is 
almost inevitably involved in mammitis, and the amputation of 
the teat affords excellent drainage for the gland and permits all 
excretions to drop away almost immediately. 

20. FURUNCULOSIS OF THE UdDER. 

Johne has recorded a special form of disease of the udder of 
the cow, under the name of furunculosis. In the cases thus re- 
corded, there occurred swellings, which were one-quarter to two 
inches in diameter, chiefly above the base of the teat. The 
swellings were quite hard and painful for a time, but after some 
weeks fluctuated and finally ruptured, discharging pus, mixed 



Woimds of the Udder and Teats 991 

with fragments of necrotic tissue. Ivater the abscesses healed, 
without serious interference with the secretion of milk. 

Johne did not determine the cause of the disease. Clinically 
it assumed an enzootic character, and appeared chiefly in stables 
where potato tops and mouldy straw were used for bedding. In 
the handling of the disease, the abscesses were opened and dis- 
infected according to general surgical principles. 

21. Wounds of the Udder and Teats. 

Wounds of the udder and teats present every possible variety 
in cause and degree. Cows which are kept in crowded stanchions 
frequently suffer from wounds to the teats caused by neighboring 
animals treading upon them. In many parts of the United 
States a very common cause of wounds to the teats of cows is 
barbed wire, especially where a fence has been badly built and 
cows have crowded through it or attempted to jump over it. If 
the cow is in full milk, so that the udder is tense and distended, 
the wounds from the barbs of the wire may be very severe and 
extensive. 

Wounds or contusions may also occur from rough milking. If 
a milker is careless in regard to his finger nails, the teats may 
be badly abraded by these. We have observed wounds, of a 
more or less serious character, inflicted by pigs or other animals 
in sucking. When pigs are allowed in the same enclosure with 
milk cows, and there chances to be a cow from which the milk 
flows involuntarily when she is lying down with the udder well 
filled, pigs, coming about, detect the milk and eat it. Following 
up the stream to its source, the pig finally acquires the habit of 
sucking the cow, incidentallj' wounding the teats with the teeth. 
In one case we observed a heifer, pregnant for the first time, ac- 
quire maternal attachment for a half-grown pig, which she 
persistently suckled. The sucking by the pig caused unimportant 
teat wounds. 

From wounds of such diverse characters, equally variable lesions 
follow, such as milk fistula, suppuration, ulceration and mammi- 
tis.- Wounds of a quiescent udder usually heal well, but if the 
cow is in milk and the lesions involve the teats it may be exceed- 
ingly difficult to milk the cow without irritating the wound and 
delaying the healing process. 



992 Veterinary Obstetrics 

As we have already stated in discussing the subject of inam- 
mitis, suppurating wounds of the active udder or teats possess 
great danger for the integrity of the gland because of their ten- 
dency to produce mammitis. Penetrant wounds of the milk 
cistern or deep wounds near the apex of the teat in milk cows are 
especially dangerous. 

In the absence of a penetrant wound, the pus flows down over 
the teat to the teat orifice, and thence the infection passes up into 
the cistern ; or the careless dairyman, finding the cow nervous 
or unruly because of the sensitive and painful teat, resorts to 
the milk tube for withdrawing the milk. The milk tube, 
probably already filthy from prior use, becomes contaminated 
further as it is being inserted, and carries infection up into the 
cistern. 

Such contamination is preventable only by the strictest possible 
precautions, consisting of the thorough disinfection of the teat- 
wound, the entire teat, and the hands of the operator ; and the 
sterilization of the milk tube. Even then the teat orifice may 
contain virulent organisms to be pushed up into the cistern on 
the end of the milk tube. 

It would be far better to aspirate the milk from the wounded 
teat by means of a cupping glass. It would cause much less pain 
to the cow, and would permit far better asepsis. 

Vennerholm suggests that, when wounds of the teats are very 
sensitive, there should be applied to them a 5% solution of cocaine 
at milking time, in order that the process may be carried out 
without causing pain. The pain of milking can always be re- 
duced greatly by first bathing the part with warm water, to which 
has been added a small amount of carbolic acid. After milking, 
the wound should always be carefully dressed with the most re- 
liable antiseptics, for which purpose we recommend equal parts 
of tincture of iodide, tincture of arnica and glycerine. 

22. Warts on the Teats. 

Warts on the teats are very common in milk cows, and differ 
greatly in form and size. As a general rule they are more or 
less polypoid or pedunculate in character, and have a very small 
neck, though they are sometimes conical or sessile. They are 
especially common on the teats of young cows. There may be 15 
or 20 or even more on one teat, scattered over the organ from. 



Stricture or Atresia of the Teats 993 

the apex to the base, and spreading somewhat over the contiguous 
udder. Generally they are not particularly sensitive, but some of 
them are markedly so, and under certain conditions and situations, 
because of being pinched in the process of milking, they may be 
quite painful, and cause the animal to become uneasy, and resist 
milking by stamping or kicking. 

If the warts are causing no annoyance to the cow and are not 
in the way in milking, they should be left alone. If they are 
causing annoyance they may be very safely clipped off with 
shears, under local anaesthesia, or cauterized with silver nitrate or 
with the thermocautery, during the dry period. One of the most 
efficient and convenient remedies for warts is the application of 
strong nitric acid. The end of a small glass rod is dipped 
in the acid, and with this the surface of the wart is cautiously 
moistened. This may be repeated every two or three days, until 
the wart contracts and the small, hard eschar drops away. If 
carefully done, not too much of the acid applied, and none al- 
lowed to touch the normal skin, no pain will be caused what- 
ever. This is of importance as affecting the temper of the 
cow. In young animals they tend after a time to disappear 
spontaneously. They may also be caused to disappear in some 
cases by the internal administration of arsenic. 

23. Stricture or Atresia of the Teats. 

In cows there not infrequently occurs stricture or atresia of the 
milk orifice, the cistern, or the milk canals, which may either 
render milking very tedious and difficult or completely prevent the 
withdrawal of the milk from the gland. While it is possible for 
similar lesions to occur in other animals, such as the ewe and 
goat, from an economic standpoint the condition is confined to 
the cow, where it exerts a very great influence upon the produc- 
tion of milk and offers an exceedingly complicated and diflicult 
problem to the veterinarian, because in the present state of our 
knowledge the handling of this group of affections is exceedingly 
unsatisfactory. 

The teats of cows show as great variety in their internal 

structure and arrangement as they do in their external form and 

size. They may show upon the internal wall of the cistern small 

gland-like prominences of a spherical form, but having no special 

63 



994 Veterinary Obstetrics 

influence upon the process of milking. The teat walls ma)' be 
very thick, leading to a small lumen of the teat canal, accom- 
panied by difEcult milking, but this condition cannot be regarded 
as pathologic. In addition to these ther^ may be transverse folds 
of the mucous membrane projecting out into the milk cistern, 
which may possibly be normal, and yet may offer some obstruc- 
tion to the passage of the milk. 

Jensen records the occasional occurrence of perpendicular par- 
titions in the cistern of the teat, constituting essentially double 
teats. There may be supernumerary cisterns, with small teat 
canals opening near the base of the teat, so that they behave as 
milk fistulae. Vennerholm states that there frequently occur, 
in the cistern, small papilloma, which interfere with the pas- 
sage of the milk by partially filling the cistern. Such 
papilloma may also become displaced and, dropping into the 
teat canal, partially block it. The cause of these papilloma is 
presumably the previous occurrence of trauma. 

The stricture or atresia may occur at any point in the teat, 
from its apex to its base. Most of the lesions are found 
at the base of the teat or in the teat canal at its apex, while 
the capacious cistern remains comparatively free. 

The symptoms of stricture or atresia will depend primarily 
upon the location of the lesion and its extent. If the stricture 
or atresia occurs in the teat canal, the teat promptly and read- 
ily becomes distended with milk, but it is exceedingly difficult 
or impossible to press it out through the teat orifice. When the 
milk is forced out, it comes away in a fine stream. 

This condition should not be confounded with those instances 
in the cow where the teat canal is normally very narrow and the 
sphincter muscle surroundirig it is very powerful, rendering milk- 
ing exceedingly difficult. In such cases, ordinarily, all four teats 
of the cow are alike, and merely require extra pressure in order 
to force the milk through the narrow canal. Such teats are 
normal upon digital palpation, and in other respects. 

By palpation of teats affected with stricture or atresia, one can 
usually recognize a hard, dense, cord-like thickening along the 
position of the teat canal, which indicates that the mucous mem- 
brane and sub-mucous connective tissue are thickened and 
indurated. 

In most cases in which the obstruction exists at the base of the 



Stricture or Atresia of the Teats 995 

teat, it is found that the milk descends slowly or not al all into 
the teat, but, if it once descends into the milk cistern, 
is easily pressed out. When the cistern is emptied, however, it 
is slow in refilling, and consequently the milking process is ex- 
ceedingl}^ tedious. In those cases of stricture where the upper part 
of the cistern is completely closed, the milk may readily be felt 
in the milk canals above, pressing down upon the obstruction, 
while the teat remains empty. Examining closely the base of 
the teat, one usually finds in the central portion of the teat base 
a hard, firm nodule, irregularly spherical in form and varying in 
size from Vz to J^ inch in diameter 

The pathologic processes which lead to a narrowing of the teat 
canal are usually referred to some traumatism, involving the epi-- 
thelium, the mucous membrane, or the sub-mucosa of the teat 
canal. Lesions of this character are assumed to follow such in- 
juries as treads, blows or rough milking. Following these 
injuries, hemorrhages may occur into the sub-mucosa, ac- 
companied by exudation into the surrounding tissues. After the 
wounded parts have become infected and inflamed, and have later 
healed, there remains a cicatricial thickening and induration of 
the epithelium and sub-mucous tissue. In some cases the thick- 
ening involves almost the entire length of the teat canal, and ex- 
tends completely around it. 

In our observation, most of the cases of stricture and atresia 
of the teat occur at the base, without any history whatever of 
traumatism or preceding mammitis. We frequently observe the 
slow formation of a nodular enlargement of a very firm character 
at the base of the teat, usually almost directly in its center, at 
the point of entrance of the milk canals into the cistern. 

As the nodule begins to form, the milker first observes that 
the milking process is retarded. Tlie milk is readily pressed out 
from the well-filled cistern through the teat orifice, but the cistern 
does not promptly refill. After waiting for a time, the cistern 
again fills and the teat becomes distended. 

Slowly and insidiously the difficulty in milking increases, and 
careful palpation reveals a firm hard nodule centrally located in 
the base of the teat. At first it appears about Vz inch or less in 
diameter, very firm, painless. It grows some, but does not attain 
a large size, usually not more than jS^^ inch. 



996 Veterhiary Obstetrics 

The teat remains empty, the nodule in the teat is very evi- 
dent, and above it are the milk canals, widely distended by 
the imprisoned milk. A chronic catarrh of the epithelium ap- 
parently exists with the new formation of dense sclerotic con- 
nective tissue in the form of a nodule. If left alone it has 
little tendency to cause marked mastitis. In a large propor- 
tion of cases, however, the use of the milk tube, sound, or 
other implement, creates a wound and deposits virulent infection 
in it, resulting finally in mammitis. If left alone the nodule finally 
causes complete atresia, and the milk is imprisoned until the intra- 
mammary pressure reaches the point at which milk .secretion can- 
not be continued, after which the quarter commences to atrophy. 
. The process is a chronic one, may continue to develop and in- 
crease week by week, but usually does not advance far enough 
to bring about complete atresia during the milking period when 
its appearance is iirst observed. After the cow is turned dry, 
however, the process continues, and leads usually to complete 
atresia, so that at the next calving, it is found that the affected 
teat is completely closed at its base, making it impossible for the 
milk to enter the cistern from the larger canals. 

The disease may affect but one teat, or may involve two, three, 
or all of them. It behaves clinically as a chronic infection, and 
appears to spread from one quarter of the cow to another, until 
each is involved and ruined. We have observed each of the four 
quarters of the udder ruined consecutively because of such nodu- 
lar growth at the base of the teat. After the cistern has been 
completely closed at the ba.se, the disease extends down, and in 
many cases brings about a complete obliteration of the cistern 
and the teat canal. 

In many other instances the atresia has its beginning in an 
ulcer involving the milk orifice. First there arises difficulty in 
withdrawing the milk from the cistern. If the nipple is carefully 
examined, it will be found to have a small, hard, sclerotic ma,ssat 
the teat orifice, usually not painful. If the milk orifice is care- 
fully inspected, there is frequently observed a red, angry ulcer, 
involving the milk meatus at the apex of the teat. Like the 
preceding disease, the course is chronic and insidious. 

There is, however, no limitation of the area in which the sclerotic 
enlargement may occur. While most of these changes are ob- 



Stricture or Atresia of the Teats 



997 



served either at the apex or the base of the teat, the intervening 
portion of the teat is nowhere exempt. 

The prognosis of atresia or stricture of the teat depends 
largely upon the position of the lesion. The outlook is the more 
favorable as the lesion is situated nearer to the end of the teat, 
and becomes more serious as it is nearer the base, or when it 
involves an extensive area in the cistern or teat canal. 

There is little danger to the life of the animal if the disease is 
left to itself, especially if the atresia is complete. If surgical in- 
terference is undertaken, except under the most rigid precau- 
tions, there is great danger of mastitis, because the veterinarian 
cannot certainlj' prevent the invasion of bacteria. 

Handling. In many cases it is advisable, especially when 
there is complete atresia at the base of the teat, to allow the 
gland to atrophy rather than assume the risk of causing infection 
by an operation, thereby completely destroying the affected 
quarter, greatly diminishing the milk secretion from all the other 




a, Pomayer's teat dilator. 

b. Aluminum dilating sounds, 

5, 6 and 7 mm. 

c. Teat sounds of Giovanoli. 

d, Concealed teat knife. 

e. Lance-shaped teat knife, with 

probe point. American. 

f , French teat dilator. 



Fig. 143. 

g, Holland teat knife and dilator 

combined, 
h, Wessel's concealed knife for 

dilating teat canal, 
i, Fraun's perforator, 
j. Teat reamer of Hug. 
k, Teat lancet of Hug. 
1, Teat dilator of Parmans. ( Hauptner. ) 



ggS Veterinary Obstetrics 

quarters, and bringing into jeopardy the life of the animal. This 
is especially true of such operations, when 2, 3 or all the teats are 
affected and the number of operations required renders serious 
mammitis well nigh inevitable. After all the danger to the 
animal, the outlook for any definite improvement is virtually 
hopeless. 

Should the veterinarian decide to operate, the essential object 
to be attained consists of a dilation of the teat canal, or of the 
communication between the teat cistern below and the milk 
canals above. Any and all operations having such an end in 
view require the strictest possible asepsis. The hands of the 
operator, the teat and the instruments must be scrupulously clean, 
and the operations must be carried out without introducing into 
the teat any form of infection or irritant. Even after an opera- 
tion has been successfully performed, from the standpoint of 
asepsis, it is still a difficult problem to so instruct a caretaker that 
he will use the necessary precautions to maintain an aseptic 
condition in the part during the process of healing. Various 
methods for overcoming the stricture or atresia have been sug- 
gested, differing in detail, and belonging essentially to two classes 
— the bloodless and the bloody dilations. 

The dilation of the narrowed canal, without the division of the 
tissues, is attempted by means of bougies or sounds. This 
method can only be applied in those cases where the lumen of 
the canal is narrowed, but not completely closed. Some advise 
the introduction of a piece of catgut about two to three cm. in 
length, bearing a head at the distal end, which will prevent it 
from slipping entirely into the teat. When this is introduced 
through the constricted portion, it swells by absorbing surround- 
ing moisture, and gradually dilates the constricted part. It may 
be inserted just after one milking, and remain in position until 
the next. Others advise the repeated insertion or prolonged re- 
tention of metallic teat sounds or bougies like b. c. Fig. 143. 

Other forms of bougies have been suggested, such as one con- 
sisting of pure gum, which exerts gradual pressure upon the part 
and brings about dilation. 

These palliative measures have generally proven unsatisfactory,, 
being accompanied by very decided danger, without any corre- 
sponding probability of permanent benefit. 



Stricture or Atresia of the Teats 999 

The dilation of the canal or cistern by incision has been quite 
largely practiced for many years, and numerous instruments have 
been devised and recommended for carrying out the operation. 
The stilette of an ordinary trocar serves the purposes of dilating 
the teat canal quite effectively, in so far as the immediate results 
are concerned. Various instruments, known as milk needles, 
and having a small caliber and the stilette of a trocar, have been 
devised for this purpose. Some operators have used a small 
lancet, a probe-pointed bistoury, or a bistoury cache. Various 
forms of the latter have been recommended, such as a and d, 
Fig. 143, and many other forms involving similar principles. 

The perforator of Fraun, Fig. 143 i, has been highly recom- 
mended by some, because with it transverse membranes may be 
perforated, and the perforation enlarged by means of the four 
blades, which can be pressed out laterally after the introduction 
of the instrument into the constricted portion. 

In addition to these cutting instruments, one requires, for 
handling the teat after the operation, one of the ordinary forms 
of milk tubes, by which the edges of the wound may be kept 
apart, and their adhesion prevented during the process of heal- 
ing, and with which the milk may be drawn with the least 
possible injur}'. It is highl}' important that milk tubes, or other 
instruments designed to remain in the teat, should be of pure 
silver, because the silver is antiseptic. 

The operative dilation of the teat may be undertaken upon the 
standing animal. The foot upon the affected side may be secured 
by passing a side line around it, and thence around the limb oppo- 
site, the end of the line being held by an a.ssistant ; or the oper- 
ator may place himself upon the opposite side to the affected 
teat, under the assumption that the cow will kick with the foot 
upon the affected side. It is better, however, that the animal 
should be cast, or still better, confined upon an operating table, 
where the antiseptic precautions can be more effectively applied. 
The instruments, hands and teat should be thoroughly disin- 
fected, and the cistern should be carefully washed out with sterile 
water. Some even recommend that the cistern be washed out 
with a I -1000 corrosive sublimate solution, by means of a 
hypodermic syringe. 

The operator grasps the teat with one hand, above the point of 
obstruction if possible, presses the milk down against the obstruc- 



looo Veterinary Obstetrics 

tion, and then introduces the instrument through the teat canal 
until it reaches the point of disease. Bang directs that, in 
case a knife is used, the incision through the constricted 
portion should be backward in an anterior teat and for- 
ward in a posterior teat, in order that the resulting 
stream of milk may be favorably directed. This applies 
only to those cases in which the obstruction is in 
the teat canal and not in the base of the teat. When the teat 
canal is sufficiently dilated, the cow loses her power to hold the 
milk, and it flows away involuntarily ; but during the process of 
healing she regains the power of retaining it. 

The after-handling consists in frequent milking and in very 
careful disinfection and cleanliness of the parts. While healing 
is going on, it is desirable to insert a milk tube daily, and retain 
it in position for several hours in order to prevent adhesion during 
the process of repair. Even with this precaution, it is exceed- 
ingly difficult to prevent a recurrence of the stricture ; and finally, 
during the dry period, complete atresia is liable to occur. 

Strebel and others recommend that the thickened tissues which 
cause the stricture should be removed by curetting. They ad- 
vise, as an instrument, a stilette with a sharp shield at the distal 
end, which may be pushed through the thickened part, and then 
forcibly drawn out, cutting away a portion of the diseased tissues. 
By repeated use, this instrument finally enlarges the canal to a 
suflBcient size, after which the treatment is of the same general 
character as that already described after dilating by cutting. 
Others use a small curette in the same way, or even a very nar- 
row-bladed knife or scalpel. 

Others have suggested incising the teat from the side, cutting 
down upon the obstacle and removing it completely with the 
scalpel, and, under strict aseptic precautions, carefully suturing 
the wound. Later great care should be used in milking, so as to 
avoid the tearing out of the sutures and the consequent estab- 
lishment of a milk fistula. The operation has not come into 
general use, because it is almost impossible to carry out the 
operation and the after-treatment with sufficient care to avoid 
mammitis. 

If the obstruction is near the end of the teat, the amputation 
of the obstructed portion immediately above the seat of the 
disease may afford satisfactory results. The operation is espec- 



Stricture or Ati'esia of the Teats looi 

ially favorable in those cases where the obstruction is quite near to 
the end of the teat, and the teat is so long that it will have ample 
length after amputation. The teat is grasped with the fingers, 
and is amputated immediately above the point of obstruction, 
either with a pair of scissors or with a scalpel. As the teat is at 
the moment somewhat stretched, the stump assumes the form of 
a crater, which favors healing. Kiihn has constructed special 
forceps, Fig. 144, for holding the teat in such a manner that the 
excision is readily performed with the scalpel. 




Fig. 144. Teat-Amputating Forceps of Kuhn. 
( Bayer and Froliner. ) 

After the teat is amputated, the milk flows away involuntarily, 
but later, as the healing process goes on, the opening narrows, 
and finally the milk is retained as before. Following the ampu- 
tation, there is little difficulty from hemorrhage, and if any occur 
it may be checked by a bandage or by a rubber band, placed 
around the teat, but not too tightly, lest it interfere with the life 
of the tissues. It ma)' be well, for a time, to prptect the wound 
against infection by means of antiseptics applied upon a cotton 
pack, which covers the wound and the teat generally and main- 
tains antisepsis for a few hours. This dressing may be retained 
in position by a ligature about the teat, or with strips of adhe- 
sive plaster. 

If it is desired to prevent the milk from escaping, it may be 
retained by the application of an elastic, or other ligature, near 
the end of the teat, sufBcieutly tight to close the milk canal, but 
not tight enough to interfere seriously with the nutrition of the 
part. 

Amputation of the teat is impracticable when the obstruction 
is located near its base. 

Vennerholm recommends that, when there are transverse mem- 
branous folds across the cistern, the teat should be as firmly 
grasped as possible above the obstruction, and then so vigorously 
pressed that the milk contained brings about a rupture of the 



I002 Veterinary Obstetrics 

band, after which the affected teat is to be very frequently emptied 
for a few days. Others attempt to rupture these transverse bands 
by still greater pressure than can be applied by means of the hands, 
but the recorded results from the operation do not seem to- 
strongly commend it. Wherever these operations are under- 
taken, mastitis very frequently follows, and the cow eventually 
becomes three-teated. 

In a somewhat extensive experience in the operative handling 
of the nodular obstruction at the base of the teat, we have had 
success in a small minority of cases ; whereas, in the larger 
number, mastitis of a more or less serious form has been induced, 
which has usually ended in the loss of the affected quarter or 
quarters. Under these conditions it seems more judicious in 
many cases to allow the gland to atrophy and the cow to become 
three-teated rather than to involve the risk of a dangerous infec- 
tion to be followed later by the destruction of the gland. 



DISEASES OF THE NEW^-BORN ANIMAL. 

I. Infections of the New- Born. 

At the time of birth there necessarily occurs a wound of the 
uew-born consisting of a division of the umbilic cord. The 
division of the cord may occur just prior to the completion of 
the expulsion of the fetus, after a portion of the fetal body has 
passed beyond the vulva, as is usually the case in those animals 
having a very short umbilic cord, like the cow and other rumi- 
nants. In other animals, where the umbilic cord is long, as in 
the mare, the fetus is usually wholly expelled before rupture of 
the cord takes place. In any animal, though extremely im- 
probable in ruminants, the entire fetal placenta may follow the 
expulsion of the fetns immediately, and the cord remain intact. 
As a general rule this presages the death of the fetus in the 
larger animals, because the separation of the fetal from the ma- 
ternal placenta has advanced to such a degree before the expul- 
sion of the young that it disturbs the aeration of its blood and 
leads to its death by strangling. In multiparous animals, where 
the fetal placenta must necessarily follow each fetus before a 
succeeding one can be expelled, the fetal membranes very fre- 
quently remain attached to the fetus by the umbilic cord, which 
is divided by the mother with the teeth. In other young which 
may be born with the navel cord unbroken, its rupture very fre- 
quently results from the struggles of the young animal, or may 
be brought about by the mother. 

The point at which the navel cord divides is usually very close 
to the umbilicus — in the foal and calf from one to three inches — 
in which region the cord is normally smaller and weaker than at 
other parts. After the rupture, the normal course of events 
consists of the retraction of the two umbilic arteries and of the 
urachus, upward and backward into the peritoneal cavity, draw- 
ing with them, in their retreat, portions of the loose connective 
tissue which immediately surround them. In this retraction the 
walls of the vessels become thickened, while their lumen becomes 
correspondingly decreased, thus preventing the escape of blood 
from the arteries or of urine from the urachus. The escape of 
urine or of blood is further safeguarded by the connective tissue, 
1003 



I004 Veterinary Obstetrics 

which is continuous with the external layer of the vessel walls, 
adheres to the divided ends of the vessels, and becomes retracted 
along with them, serving to close over the broken ends and form 
a fibrous network which offers an impassible barrier for the blood 
or urine. 

The umbilic vein, having very thin walls, collapses at once 
after rupture, so that its lumen is closed and what blood remains 
within, being free from any cardiac or capillary pressure, soon 
coagulates and blocks the remaining cavity. The Whartonian 
gelatine included within the cord rapidly loses its fluid portion, 
which oozes away from the broken end ; within a few hours 
the navel becomes dessicated to a hard, dry crust, which hermet- 
ically seals the surface of the wound, and aseptic healing occurs 
beneath the scab. 

Prior to the hermetic sealing of the wound by dessication, it 
is open to infections of an extended variety, which acquire special 
significance because of the vulnerability of the tissues involved. 

The tissues of the umbilic cord, including the urachus, veins 
and arteries, invested with connective tissue and Whartonian 
gelatine, become dormant when the cord ruptures, and possess 
little or no power of resistance against bacterial invasion. The 
conditions prevailing at this epoch rather invite infection, as the 
tissues provide abundant moisture, nutrient material and warmth 
for bacterial growth. 

Opportunities for infection are not wanting. Even before the 
fetus has escaped from the vulva or the cord has ruptured, any 
infection existing in the vulvo-vaginal canal of the mother may 
have acquired a habitat on or in the cord. Nocard and others 
hold that the appallingly fatal infectious diarrhea of calves is due 
chiefly to navel infection, and that the infection is already lying 
in wait in the vulvo-vaginal canal of the cow when the calf is 
being born. Later, when the cord ruptures, the umbilic stump 
is readily brought in contact with the earth, bedding, dung, 
urine, etc., whence it may acquire virulent infections. 

The anatomy of the part permits the infection to reach the 
circulatory system by a short route through the inert, open 
umbilic vein, and to be carried thence to remote parts. 



Puruleiit hifedion of the Navel 1005 

I. Purulent Infection of the Navel. Omphalitis. 
Omphalo-phlebitis. Pyo-septh^mia. 

Purulent infection of the navel is greatly favored by many of 
the circumstances attending the birth of the young animal. 
When it is born in a stable or barnyard, or in surroundings where 
filth and dirt are abundant and omnipresent, there is constant 
exposure to infection of the new-made wouud. Whenever the 
animal lies down, especially in sternal recumbency, the new-made 
wound comes in direct contact with infected bedding, decompo- 
sing feces or urine, or with other filth which may chance to ex- 
ist at such a point . 

The carnivorous, and to a lesser degree the herbivorous mother 
habitually cleanses the broken cord by licking, and thereby with- 
draws from it a large part of the Whartonian gelatine, thus 
favoring the early dessication of the stump. It appears that, in 
spite of the fact that the mouth usually abounds in pathogenic 
bacteria, the process of licking the navel is, according to clinical 
observations, comparatively safe and tends to protect the navel 
against infection. We observe infection of the navel most fre- 
quently in the foal, whose mother pays less attention to the 
navel than do other domestic animals. 

Purulent infection of the navel very frequently arises, also, as 
an indirect result of ligating the umbilic cord. The danger from 
ligating the cord con.sists usually of two principal elements — the 
infection of the wound by careless ligation, and the providing of 
a breeding ground for bacteria by the inclusion of the Whar- 
tonian gelatine. 

From a surgical standpoint, nothing can well be more danger- 
ous to the new-born animal than the careless or filthy ligation of 
the umbilic cord by a layman or a veterinarian with dirty, in- 
fected hands and an unclean ligature. Most ligatures applied to 
the navel are placed there by laymen, who are ignorant of the 
fundamental rules and practices of surgery, and consequently 
pick up almost any kind of ligature, which they apply without 
disinfection or sterilization, and usually without disinfecting or 
even washing their hands. They thus bear directly to the cord 
abundant infection of a dangerous character. 

Even when a ligature is applied to the navel under some of 
the rules of modern surgery, other important ones are habitually 



ioo6 Veterinary Obstetrics 

neglected, and the ligature is nevertheless wrongly and danger- 
ously placed. The exterior of the cord consists of the imper- 
meable amniotic sheath, which encloses within it the vessels sur- 
rounded b}' the Whartouian gelatine. If the cord is tightly 
ligated, the gelatine is firmly enclosed, and its fluid portions can- 
not escape readily and permit proper dessication of the stump. 
Even if the ligature has been applied under other antiseptic pre- 
cautions, but retains the Whartonian gelatine, the procedure is 
at once in conflict with surgical practice, because this substance 
constitutes an excellent medium for the growth of pathogenic 
bacteria and assumes the same surgical significance as extensive 
blood clots when retained in a wound. The danger from infec- 
tion is further emphasized if the ligature is placed at a point too 
distant from the umbilicus, thus increasing the amount of tissue 
in the cord which must undergo dessication or putrefaction. The 
greater the amount of moist tissue, the more probable is putre- 
faction, and the less likely is dessication to occur. 

Ligation possesses yet another danger, in the possible incarce- 
ration of the two umbilic arteries and the urachus. If the 
ligature is applied very tightly before the cord is severed, the 
retraction of the arteries and urachus into the abdominal cavity 
may be prevented. Being retained in the navel, the open ends 
of the arteries and urachus are freely exposed, and rendered more 
subject to infection during putrefaction of the tissues. 

The possibility of either preventing or decreasing navel infec- 
tion by ligating the stump is by no means clear upon surgical 
grounds. When a living tissue is ligated, and the ligature so 
tightly applied as to cause necrosis on the distal side, it appears 
clinically to cause a prompt protective reaction (leucocytosis) on 
the proximal side of the ligature, which largely serves to prevent 
important infection. But when a ligature is applied to a dormant 
or dead tissue like the umbilic stump, no such reaction is caused, 
and the stump goes on to putrefaction or dessication, as circum- 
stances may favor. The application of a ligature about a mass 
of dead tissue cannot prevent infection of the necrotic mass on 
either side of the ligature, but may greatly favor putrefaction by 
confining fluids within the parts. When such bacterial infection 
and decomposition occur in the necrotic tissues of the cord, the 
more or less dormant vessels incarcerated in the decomposing 
tissues are seriously exposed to bacterial invasion. 



Purulent hifedion of the Navel 1007 

It is thus a common clinical observation that purulent infec- 
tion of the navel is greatly favored by the process of ligation, 
and the more improperly ligated the greater the danger. Ad- 
mittedly a navel cord may be safely ligated. If the cord is di- 
vided at the proper point, the Whartonian gelatine thoroughly 
pressed out and the stump ligated under perfect aseptic precau- 
tions, followed by the application of an aseptic covering, and its 
retention in position and in an aseptic state (a very difficult task 
with domestic animals), the operation is safe. 

Another method by which infection apparently takes place is 
through the medium of flies, which are attracted to the cord 
while it is yet moist after birth. These filth carriers, having 
previously been in contact with infected wounds or putrid organic 
matter, carry the infection to the navel. Foals born during fly 
time very frequently suffer from navel infection. 

Symptoms. Navel infection occurs within a few hours after 
birth, and the danger is eliminated as soon as the cord is thor- 
oughly dessicated. Consequently, the danger period is during 
the first 12 to 24 hours after birth. The symptoms usually fol- 
low very promptly after this period, although in the initial 
stages of the disease, the malady may be overlooked or unrecog- 
nized by the owner or attendant. First there usually occur the 
general symptoms of local infection, modified by the peculiar 
structure of the navel. In the foal, Fig. 90 B, page 559, there 
is an extension of a hairless skin from the umbilicus, to con- 
stitute the cutaneous portion of the cord, beyond which the 
■cord is somewhat smaller, softer, more fragile, and covered with 
the amnion. It is just beyond this cutaneous area of the cord 
that it normally ruptures. 

When the umbilicus becomes inflamed, this projection of hair- 
less skin becomes intensely reddened, tense and glistening. 
Further examination will reveal the fact that, instead of the part 
liaving dessicated normally, there exudes from near the center 
-of the cord a dirty, thin, watery, flocculent serosity, which may 
be grayish-white or tinged with blood. If the part is carefully 
examined with a fine probe, it will usually be found possible to 
pass the instrument upward and forward for a variable distance 
toward the liver along the course of the umbilic vein. If the 
infection has extended along the vein in its course through the 
peritoneal cavity, the probe can probably be passed for a distance 



ioo8 Veterinary Obstetrics 

of two, three or four inches, or even more. If the infection has 
been arrested in the umbilic ring, the probe cannot pass be- 
yond it. 

The behavior of the case will depend primarily upon the degree 
of extension of the infection. It may be confined chiefly or 
wholly to the umbilicus itself, to constitute simple o^nphalitis r 
or it may pass beyond the umbilicus, in the lumen of the umbilic- 
vessels, and the infecting agent and its products gain entrance 
into the blood stream, by which they may be carried to distant 
parts, to produce septic or pysemic disturbances of a grave char- 
acter, which we recognize as omphalo-phlebitis or pyosepthaeinia 
of the new-born. 

It is an important clinical fact that the gravity of navel 
infection is usually in inverse proportion to the local dis- 
turbances. If the local changes are great, inducing severe local 
omphalitis, the sj^stemic disturbances are usually unimportant ; 
if the infection gains admission to the umbilic veins, and thence 
enters the general circulation, the local disturbances may be com- 
parativeljr insignificant, while the sepsis or pyaemia is exceed- 
ingly grave. 

When the infection remains localized in the umbilicus itself,, 
the part becomes swollen, somewhat tender to the touch, and 
soon suppurates. Small abscesses form in and about the um- 
bilicus, which open and discharge pus. The abscesses may be 
followed b)' fistulae of varying lengths, into which a probe may 
be passed for a distance of one, two or more inches. Sometimes the 
fistula may consist of the suppurating walls of the umbilic vein 
or artery. The swelling from local umbilic infection may be 
very great, sometimes offering a sharp, hemispherical swelling, 
4-6 inches in diameter. 

The course of such local infection is usually chronic, continuing 
for week after week. A somewhat limited amount of pus is dis- 
charged, which is generall}' of an ordinary consistency, without 
odor. Such an inflammation does not involve the general well- 
being of the young animal ; it takes its food in the normal man- 
ner and amount, its digestion is undisturbed, it is playful, and 
its growth is usually unaffected. 

When the infection, instead of expending its virulence upon 
the tissues of the umbilicus, gains admission to the open umbilic- 
vein and extends along its course toward the heart, and the 



Purulent Infectio7i of the Navel 1009 

bacteria and their products enter the blood stream, the symptoms 
are wholly different from those of the local disease. The coagu- 
lated blood within the umbilic vein breaks up under bacterial 
invasion, liquifies, and may be partly discharged into the hepatic 
vein from the central end of the umbilic vein, and externally from 
the stump of the cord as a dirty, fiocculent, reddish-gray liquid, 
consisting of the disintegrated blood clot mingled partly with pus. 
The entire lumen of the umbilic vein has become a suppu- 
rating cavity. The tissues about the umbilicus are slightly, if at 
all swollen, but the umbilic stump is swollen, tense, glistening, 
and projects out from the umbilic ring as an elongated cone, 
having in its center a very small opening, from which the dis- 
charge appears. This discharge may occur as early as the 3rd or 
4th day after birth, and may continue for a period of one, two, 
or even more weeks, should the animal survive. During the 
continuation of the discharge from the umbilic vein through the 
stump, the hairs about the navel are kept befouled and moist. 
Usually the adjacent hairs become matted together, and may 
more or less hide the broken end of the stump. Later the be- 
fouled, matted hairs drop away, leaving a depilated, naked surface. 

Sooti after the commencement of suppuration in the umbilic 
vein, there frequently occurs also a corresponding infection in 
the broken end of the urachus, which results in the duct becom- 
ing reopened, with a consequent dribbling of urine from the 
navel, which adds to the moist condition of the diseased part and 
gives to it the odor of decomposed urine. Usually this condition 
is attributed to " persistent " urachus, but according to our ob- 
servations, this designation is ordinarily erroneous, since the 
open condition of the urachus with dribbling of the urine is gen- 
erally secondary. 

In the more serious cases of navel infection, the local symptoms 
are so insignificant in a general way that they may wholly 
escape the observation of the owner or caretaker. The first 
signs of disease which he notes are the more serious systemic dis- 
turbances, becau.se of the entrance of the infection into the 
general circulation. When the young animal has reached the 
age of two to four daj-s or somewhat more, there suddenly appears 
in many cases a high fever, with loss of appetite and extreme 
dullness. The udder of the mother becomes over-distended with 
64 



loio Veterinary Obstetrics 

milk as a consequence of the loss of appetite of the 3'oung. The 
coat of the 3-oung animal is staring and dull. There maj' exist 
either constipation or diarrhea. In many cases distinct chills are 
noticed as a symptom of the fever which is present. The 3'oung 
animal in many cases shows very great weakness, and may perish 
from the infection in the course of 24 to 48 hours after the first 
sj'mptoms of disease are observed. 

The symptoms of general infection vary widely in intensit}'. 
Between the rapidly fatal septicaemia which we have outlined 
and those cases which for a time do not attract any notice, 
there is ever\' gradation. In manj' cases the symptoms of fever 
continue for a day or two, with a decreased appetite and other 
general febrile symptoms, disappear, and the j'oung animal ap- 
parently^ regains its usual health, although it ma}- not seem quite 
as vigorous as should be expected. 

In .some of the very mild cases, no febrile symptoms appear of 
such a character as to attract the attention of the owner, and 
the early stages of the general infection pass unnoticed. This 
very frequently occurs, and it is only when the secondar}' sj'mp- 
toms of the infection arise that the attention of the owner is at- 
tracted to the diseased condition of the patient. 

When the j'oung animal has reached an age of from three to 
five or even ten days, and sometimes more, there suddenlj' ap- 
pear, without warning, acute septic or pj'Eemic inflammations of 
various parts or organs of the bod}'. Pre-emineutl}' there occur 
septic or pj'semic inflammations of the articulations. The j'Oung 
animal is left apparentl}' well in the evening, and is found the 
following morning severely lame in one of its limbs — usuallj' so 
lame that it will not bear weight upon the affected member. 
Upon examination of the limb, one of the prominent articulations 
is found swollen, hot, tense, and painful upon manipulation. 
The inflammation usually affects the more important articula- 
tions, especialh' the hock and stifle, and less frequently the elbow 
and carpus or other joints. The suddenness and iutensitj' of the 
arthritis usually leads the owner to believe that the dam has in- 
jured the joint of the young by treading upon it. 

The course of the inflammation of the articulation varies ac- 
cording to circumstances. In manj' cases it increases in intensitj' 
for a few hours in the articulation first involved, and then very 
suddenly abates, while another articulation becomes violently 



Pumle7it Infection of the Navel loi I 

inflamed. The inflammation may thus involve one after another 
of the articulations, disappearing from one to reappear in another. 
This has caused the disease to be designated by some as rheu- 
matoid arthritis, and by others as foal lameness, calf lameness, 
etc. As the disease continues, there is a well-marked tendency 
for the arthritis to become fixed and permanent in a given articu- 
lation, and at the same time additional articulations become in- 
volved, so that in many instances two, three, or four joints are 
simultaneously diseased. 

We recognize two somewhat distinct forms of arthritis ; the 
one a serous inflammation without the formation of abscesses, 
the other characterized by the presence of abscesses, the con- 
tents of which are usually mixed with synovia. The apparently 
serous arthritis, in which abscesses do not form, constitutes the 
most common type of articular disease. 

The inflamed articulation is greatly enlarged, tense, hot and 
painful. The distended synovial sac may offer some symptoms 
of fluctuation, but does not "point." Later the articular tissues 
hypertrophy, the subcutem, synovial membranes and other parts 
thicken and become more or less sclerotic. At the same time 
the contents of the synovial sac may become increased, caus- 
ing severe distension, whicli may remain permanent. When in- 
volving the femoro-patellar articulation, the synovial disten- 
sion floats the patella upwards until it reaches the level of the 
top of the external femoral condyle, when the patella slips out 
laterally to constitute "floating luxation of the patella" which 
may prove temporary or permanent. 

Less frequently the arthritis is of a purulent character, and the 
joint soon becomes the seat of an extensive suppuration, the pain 
is very severe, and the accompanying constitutional symptoms are 
exceedingly grave. After the lapse of a few days, the pus in 
the synovial sac becomes so abundant that distinct fluctuation is 
present. Unless opened surgically, the abscess ruptures and 
discharges a flocculent pus mixed with abundant synovia. In 
most cases, however, the sepsis is so acute and severe that the 
young animal perishes before the abscess ruptures spontaneously ; 
or, if the abscess is opened, the animal soon succumbs from 
septicaemia. 

The abscesses are not confined to any particular articulations 
of the body. They are observed chiefly about the principal 



IOI2 Veterinary Obstetrics 

articulations of the limbs, such as the tarsus, carpus, fetlock and 
stifle, but usually do not include the coxo-femoral or scapulo- 
humeral joints, though somewhat rarely these are involved. 
When the hip joint becomes affected, the symptoms are not so 
well defined, because of the depth of the abscess. The animal is 
excessively lame in the affected hip, and there is a general swell- 
ing of the gluteal region. The imprisoned pus finally approaches 
the exterior at some point, causes fluctuation if the young 
animal lives for a sufficient time, and may then rupture or be 
opened, and the true character of the disease becomes revealed. 

The severe lameness caused by the arthritis exerts an impor- 
tant influence upon the course of the disease, aside from the 
septicaemia with which it is so closely associated. The lameness 
interferes with the young animal securing proper nourishment, 
because in many instances it is unable to rise or even to stand 
while it sucks, and thus it suffers from starvation. In chronic 
cases, also, the young animal suffers greatly from decubitis 
gangrene upon various portions of the surface of the body, so 
that from these sores alone it may soon become a very repulsive 
and pitiable object. 

The formation of pyaemic abscesses does not confine itself to 
any organs or tissues, but may occur at almost any point 
within the entire body. Abscesses may form within the lungs 
and, rupturing into the bronchial tubes, cause death from an 
acute septic pneumonia. In other instances the abscess forms in 
the articulations of the vertebral column, and may extend in- 
ward to press upon the spinal cord, thereby inducing a more or 
less sudden and complete paralysis ; or the abscess may form in 
the spinal canal and bring about similar symptoms. 

Spinal paralysis, due to pysemic abscess as a result of navel 
infection, may cause either sudden or gradual paralysis. If the 
abscess forms in the inter-vertebral space, and suddenly forces 
its way into the spinal canal to cause pressure upon the cord, 
the paralysis may be very sudden and unexpected, as we noted 
in one instance where a foal had been apparently well and very 
thrifty and vigorous until some 8 or lo weeks old, when it was 
found one morning unable to rise. It could not stand when 
helped to its feet, and presented all the appearances of a broken 
back. Upon post-mortem examination, there was discovered a 



Purulent hifection of the Navel 1013 

small abscess at the dorso-lumbar articulation, which, rupturing 
into the spinal canal, had caused pressure upon the spinal cord. 

In another instance, in a calf, there appeared at the age of 6 
or 8 weeks a gradually increasing paraplegia. The caretaker 
had not observed any disease or infection of the navel, but a 
careful inspection of the part revealed the presence of an old 
suppuration, the evidence consisting chiefly of dried pus upon 
the surrounding hairs, and a naked point at the navel, indicating 
that a limited infection of the part had existed. Being unable 
to account otherwise for the paralysis, we diagnosed spinal 
abscess as a result of navel infection, and finally, destroying the 
animal, we discovered upon post-mortem examination a large 
abscess in the spinal canal, pressing upon the cord, as shown in 
Fig- 145- 




Fig. 145. Omphalo-Phlebitis. 
Spinal abscess, in a four-weeks-old calf. 
A, Inspissated pus in spinal canal, pressing upon the spinal cord, SC, 
causing paralysis of posterior parts. 

Pathology. The disease is the result of the entrance, into 
the freshly broken navel, of pus-forming micro-organisms. So 
far as we are aware, the disease is not limited to any one form of 
infection. In one instance, where a foal had succumbed to the 
disease, bacteriologic examination of deep-seated pyaemic 
abscesses revealed the presence of a pure streptococcic infection. 
The local infection of the navel is a mixed one, as has been 
shown by Bollinger and others. Clinically we observe that, 



IOI4 Veterinary Obstetrics 

along with the general purulent infection, there maj' also occur 
a tetanus infection, inducing a virulent form of that malady. 
Nocard and others have shown that, in calves, along with other 
infections, or without them, there may enter through the broken 
navel cord the germs of infectious diarrhea. One organism or 
another may acquire precedence, and consequently modify the 
symptoms of the infection. 

The force of the infection is sometimes expended upon the 
navel and its immediate neighborhood, producing a type of dis- 
ease depending somewhat upon its virulence. In such cases 
it appears that a sufficiently resistant embolus forms in the um- 
bilic vein to constitute an efficient barrier against the centripetal 
progress of the infection and limit its ravages to the umbilic 
region. The infection induces a more or less severe inflamma- 
tion, with swelling, suppuration, and the formation of abscesses 
and fistulse. If the infection possesses a still higher virulence, 
gangrene or necrosis of the tissues may occur. 

If the infection extends beyond the immediate area of the 
navel through the lumen of the umbilic vein or other umbilic 
vessels, it quickly gains entrance to the general system, and 
induces septicaemia or pyaemia. Upon post-mortem examina- 
tion in such cases, the navel vein is usually found filled with 
decomposed blood, mixed with a dirty-gray, flocculent pus. 

The umbilic vein is converted into a vast suppurating tube, 
opening at one end into the hepatic vein, at the other externally 
at the umbilicus. The purulent contents may escape outwards 
through the navel or inwards into the hepatic circulation. Once 
the infection reaches the hepatic circulation, it flows freely to 
the heart, passes through the pulmonary system and gains the 
systemic circulation. The gravity of the attack is dependent 
upon the amount and virulence of the infection entering the 
hepatic circulation, and the power of resistance (age and vigor) 
of the patient. In many cases the septicemia is so acute and 
intense that the patient succumbs in a few hours, presenting 
essentially only the symptoms of high fever with very slight 
navel disease. 

In other instances the disease assumes the character of 
pyaemia, and the clumps of bacteria, passing into the general 
circulation, are forced through the pulmonary vessels, into the 
lungs, where they may lodge to bring about pulmonary abscesses. 



Purulent Infection of the Navel 



1015 



Passing through the pulmonary capillaries, and reaching the 
systemic circulation, the infection may become arrested at any 
point, and induce an acute septic or pyasmic inflammation. The 
infection is especiallj' liable to become lodged in the capillaries 
in or about the synovial membranes of the articulations or of 
the sheaths of tendons, and to induce therein either an acute 
serous or purulent inflammation. 




Fig, 146. Abscesses of Umbiwc Vein and Arteries in Omphalo- 
phlebitis OF Foal. 

A section of the abdominal floor, iircluding the umbilicus, seen from above. 
B, Bladder. 
U, Emergence of umbilic vein from naval cord into intra-peritoneal 

portion of that vessel. 
UA, Umbilic arteries retracted to the fundus of the urinary 

bladder, B, 

1, I, Pus cavities in umbilic vein. 

2, Abscess in right umbilic artery. 

3, Greatly thickened walls of left umbilic artery. 

4, A brief segment of apparently normal artery. 

5, Thrombus in posterior aorta and iliac arteries. 

No tissue or organ of the body is immune against the ravages 
of the disease. The internal organs are b}' no means free from 
the dangers of pyaemic infection. Abscesses of the liver, kid- 
neys and spleen are frequently found. 

We have frequently observed abscesses within the umbilic 
veins and arteries, as shown in Fig. 146, especially when ..these 
vessels have been caught and held as a consequence of the 
ligation of the umbilic cord. If the cord has not been ligated, 
and the arteries thus held, they quickly retract into the abdomen 
and are comparatively free from danger. 



ioi6 



Veterinary Obstetrics 



Pyemic arthritis is usually highly destructive to the affected 
articulation. When the focus of infection is within the articu- 
lation, the synovial membranes are found greatly thickened, 
intensely injected, and frequently necrotic. The articular cavity 
is usually distended with purulent synovia, as indicated at A A 
Fig. 147. The infection spreads rapidly to the surrounding tis- 
sues, causing extensive suppuration in the neighboring tendon 
sheaths, like at C, and in the subcutaneous tissues at B. 




Fig. 147. Omphalo-phi,ebitis. Foai,. 

Sagittal section from carpus. Same case as Fig 146. 

A, A, Intra-articular abscess of carpal joint, communicating 
with, an extensive subcutaneous abscess, B, and posteriorly 
with an empysemic cavity, C, in the vaginal sheath of the 
flexor tendons. 

The articular cartilage undergoes rapid destruction, as shown 
at A and B, Fig. 148. In addition to the lesions already men- 
tioned, there may occur septic inflammation of the pleura, inter- 
muscular abscesses, opthalmia, leptomeningitis, catarrhal enteri- 
tis, pneumonia, myocarditis, bronchitis, etc. 



Fig. 148. Omphalo-phlebitis. 

Cross section of Fig. 147, showing lower row 
of carpal bones, seen from above. 
A, B, Purulent destruction of articular cartilage. 

At the upper part of the illustration is seen the 
pus cavity, B, of Fig. 147, in cross section. 




■%^ 



Purulent Infection of the Navel 1017 

Prognosis. The prognosis is very grave in all cases of 
■oraphalo-phlebitis, that is, in all patients suffering from umbilic 
infection in which the infection gains the hepatic and general 
-circulation. It is most hopeless in the foal, in which animal the 
mortality exceeds 95%. Of the few which ultimately sur- 
vive, the vast majority are comparatively valueless because 
-of permanent changes in the articulations or in other parts of 
the bodj'. In the calf the prognosis is somewhat more favor- 
able, but is still exceedingly grave. The greater the age of the 
young animal when the symptoms of the disease appear, the 
more vigor and strength it has acquired ; the better the progno- 
sis. If the infection is so mild that the first evidences appear 
-only after the young patient is 2 or 3 weeks old, the prognosis 
is fair. 

When simple omphalitis is present and severe, and the local 
swelling and inflammation indicate that the entrance of the in- 
fection into the general system is barred by a resistant embolus 
in the umbilic vein, the prognosis is good. 

Handling. The handling of the localized infection of the 
-navel consists e,s.sentially of local disinfection. The navel should 
Tdc thoroughly cleansed , and if a portion of the cord is still present 
and undergoing decomposition it should be cautiously removed, 
and any necrotic tissues should be excised or curetted away as 
far as is practicable. Abscesses in the navel should be opened 
promptly, under strict antiseptic precautions. It is highly essen- 
tial, also, that, before attempting to operate, one should care- 
fully differentiate between inflammation of the navel and 
umbilic hernia. In some cases the two conditions coexist, and 
laecome highly confusing, so that the hernia may be mistaken 
for an abscess, or vice versa ; or a fistula may exist along with 
hernia. When attempting to la}' open a fistula, the surgeon 
may open the peritoneal cavity and invite intra-peritoneal infec- 
tion, or a protrusion of the omentum or the intestine. Sup- 
purating fistulse about the navel should usually be treated* by 
the injection of antiseptics, such as tincture of iodine, rather 
than by opening, unless the more conservative method fails to 
produce the desired results. 

The selection of a disinfectant is not so important as the thor- 
oughness of its application, except that it should be one which 
will penetrate the tissues freely, We prefer the application of 



ioi8 Veteriyiary Obstetrics 

the tincture of iodine or of other antiseptics in alcohohc solution. 
They have the advantage that the alcohol quickly evaporates and 
leaves the antiseptic behind in a dry state. It may be equally- 
effective to apply a wet dressing to the part, in the form of au 
antiseptic pack, to be retained in position by means of a band- 
age. If this is attempted, the pack needs be kept constantly 
saturated with the antiseptic and frequently renewed. 

When the infection has become general, and septicaemia or 
pyaemia has developed, all forms of handling become almost 
hopeless. In accordance with general surgical principles, we 
would promptly open abscesses, and disinfect their cavities 
whether they involve the muscles or the articulations. Inter- 
nally there may be given various antiseptics, and we especially 
recommend large and repeated doses of quinine, or in the foal 
we may add to the quinine large doses of potassium iodide, or 
supplant the quinine by the iodide. 

Recent developments in opsonic and serum therapy have 
aroused interest, and in the minds of some, hope has been estab- 
lished that pyo-septicaemia of the new-born may be brought 
under control. As yet, the problem is undecided. Spencer 
(Proc. Am. Vet. Med. Ass'cn., 1908, p. 393) claims definite re- 
sults in severe cases, but the data submitted are not convincing. 
Most of his cases were comparatively old foals, in a fair proportion 
of which spontaneous recovery might have been anticipated. 
He gave 10 cc. of anti-streptococcic serum subcutaneously, 
daily. No evidence is submitted that the foals had streptococcic 
infection. If the infection was streptococcic, we have no evi- 
dence that the serum was from the same organism. In about 
half his cases, S. used influenza serum instead of the antistrep- 
tococcic preparation. In one case he combined them. Were 
we to accept the conclusion that the sera acted specifically in 
these cases, we would be forced into the position that the charac- 
ter of the infection is unimportant, and all that is necessary is 
to buy some kind of serum from a manufacturer, administer it 
in any kind of infection, and get a speedy cure. 

It is to be sincerely hoped that investigations along these lines 
may develop a safe and reliable remedy for umbilic infection of 
the new-born, but until we are supplied with more definite data 
regarding this or other remedies, the practitioner needs rely upon 
prophylaxis, not upon therapeutics. 



Purulent Infectio7i of the Navel 



1019 



While the handling of pyo-septhsemia of the new-born is ex- 
ceedingly unfavorable and well-nigh hopeless, prophylaxis of 
navel infection is highly successful, and should be regularly ap- 
plied in stock-breeding, especially in horse-breeding. Franck 
recommends that, after the navel cord has been ligated, it should 
be penciled over with concentrated carbolic acid, but Vennerholm 
contends that this converts the covering of the cord into a parch- 




FiG. 149. SoHNi,E's Navei, Bandage for Foai^s. 
■a. Elastic girth inserted in the suspensorium. (Bayer & Frohner). 

ment-like membrane, which interferes with the escape of the 
tissue-fluids, and consequently with the mummification of the 
cord. He recommends instead the plan of Sohnle of Wurtem- 
berg, who uses a special navel bandage, as shown in Fig. 149. 
Vennerholm recommends that the surrounding parts be carefully 
shaved, in order to prevent the adhesion of dirt. The navel is 
then disinfected, and further protected by the application of the 
Sohnle apparatus. The leather surcingle, and other parts of this 
apparatus, are well padded, to prevent galling of the young ani- 
mal, and applied as shown in the figure. The navel rests in a 
depression in the surcingle, in which there is placed sterilized 
cotton, upon which the disinfected navel rests. The parts are 
disinfected and redressed daily, until the navel stump sloughs 
away and granulation is fully established. 

The plan of Vennerholm and Sohnle is admittedly good if 
thoroughly applied, but it requires a very long and tedious course 
of procedure, with a somewhat expensive apparatus and no 
little annoyance to the foal. It is dangerous to entrust such a 



I020 Veterinary Obstetrics 

method of handling to laymen, but the remedy demands applica- 
tion by the veterinarian himself. Unless properly applied, 
closely watched and carefully reapplied, the pad quickly becomes 
befouled and at once acts as a retainer and promoter of infection. 
In our judgment, so complicated a method of handling is alike 
needless and dangerous. 

In our experience we have had most excellent results by a far 
simpler method, which we believe safer and more efficient. We 
provide the breeder with a dessicating antiseptic powder for ap- 
plication to the navel cord as soon as the foal or other young 
animal is born. This powder may be variously compounded, 
according to the taste of the veterinarian, but should consist of 
reliable antiseptics having a distinct dessicating power. We 
would suggest, for such a powder, equal parts of iodoform, tannin, 
oxide of zinc and starch, all finely powdered and mixed. The 
oxide of zinc might be displaced by calomel, or the latter might 
be added to the compound suggested. Quite as good, or per- 
haps even superior, is a powder consisting of equal parts of dessi- 
cated alum, gum-camphor and starch, finely powdered and thor- 
oughly mixed. The latter mixture is especially efficient in 
keeping flies away from the moist cord. 

For the application of such a powder, the owner or veterina- 
rian should first thoroughly cleanse and disinfect his hands. If 
the navel has become soiled, it also should be cleansed and dis- 
infected. The navel cord should not be tied. We have al- 
ready stated our objections to ligating the cord, on page 1005. 
If it is unruptured, the caretaker, after disinfecting his hands, 
should pull, tear or scrape the cord in two, under antiseptic pre- 
cautions, at a distance of about two or three inches from the 
navel, after which, with his thumb and finger, he should press 
out from the stump the Whartonian gelatine and fluids. After 
this has been well done, the powder should be dusted over the 
stump of the navel very freely and repeatedly, until the rem- 
nant of the cord has become completely dessicated and the navel 
hermetically sealed. 

If the application is repeated three or four times at intervals 
of one-half hour, the stump of the cord is well mummified with- 
in two to four hours and the danger from infection is eliminated. 
The horse-breeder should be impressed with the fact that the 
efficacy of the remedy depends wholly upon the early and 



Teta7iits of the New-born 1021 

thorough application, and that any delay or carelessness is liable 
to vitiate the result. 

Antistreptococcic serum has been heralded as a valuable prophy- 
lactic against this infection, but is wholly needless. Local 
cleanliness is ample, and other means superfluous or worse. Few 
diseases of animals are more subject to safe, convenient and 
economic prevention than navel infection of the new-born. Its 
success calls for fidelity to cleanliness on the part of the owner, 
preceded by timely and intelligent advice by the veterinarian. 

2. Tetanus Neonatorum. 

Tetanus of the New-born. 

Tetanus of the new-born acquires special significance because 
of the avenue of entrance of the tetanus bacilli. While tetanus 
may appear in any new-born animal from the same causes which 
induce it in the adult, it is of especial interest to us when occur- 
ring as a result of navel infection. Owing to the method of 
infection, the maladj^ acquires a distinctive name, though differ- 
ing in no essential respect from the ordinary disease, except per- 
haps that it is more virulent because the toxic substances enter 
more freely and directly from the umbilic vein into the general 
circulation. In domestic animals, tetanus of the new-born is 
chiefly confined to the foal. 

The symptoms of tetanus of the new-born are identical with 
those observed in the adult animal, except that in our observa- 
tion the onset is more sudden, the course more violent, and 
death more certain. We have not observed a recovery, but in 
the few instances which we have seen the course of the disease 
has been especially brief and stormy. As a general rule the foal 
goes down and is unable to stand within 24 hours after the first 
symptoms are noted. 

If the navel is examined in these cases, so far as we have 
observed, there is found in each instance a well-marked purulent 
discharge emanating from the navel vein. 

The disease is handled the same as other cases of tetanus, but, 
so far as we have observed, is hopeless from the outset. 

Tetanus of the new-born may be safely and readily prevented 
by the same precautions which we have suggested in the fore- 
going article, for ordinary purulent infection of the navel. 



I022 Veteri7iary Obstetrics 

3. DYSENTERIA NEONATORUM. DYSENTERY OF THE NEW-BORN. 
WHITE SCOURS. 

In all new-born animals there m.a.Y occur disorders of the di- 
gestive tract, which are expressed chiefly in the form of dysen- 
tery, due as a rule to the entrance into the alimentary canal, and 
multiplication therein, of various forms of bacteria which induce 
a catarrhal inflammation of the alimentary mucous membrane, 
accompanied bj^ an acute diarrhea. While the disease ma}^ affect 
the new-born of any species of animal, it is most common and 
fatal among calves. In this animal there is a distinctively infec- 
tious form, in which the disease becomes enzootic, and assumes 
the proportion of a very destructive plague in dairy herds. 
The calf is no more subject to digestive disturbances, aside from 
the infectious diarrhea, than are other new-born animals. In 
fact it maj^ well be questioned if dysentery of the new-born ani- 
mal is not more common in the foal, when we leave out of con- 
sideration the specific dysentery of the calf. 

a. Sporadic Dysentery of the New-Born. 
White Scours. 

Dysenter}' of the new-born consists of a diarrhea which at- 
tacks the j'oung animal, usualh* during the first few days of 
extra-uterine life. The disease appears occasionallj' among all 
species, especially among foals and calves. 

Symptoms. When the 3'oung animal has reached the age of 
two to ten days, symptoms of general illness of a more or less 
severe t3^pe appear. 

The feces are very fluid, and usually somewhat mixed with 
mucus. They are generally fetid, and vary in color, frequentlj' 
being of a dirty yellowish or whiti.sh tinge. They may partake of 
the peculiar coloring of the foods consumed, so that, in case the 
young animal partakes of green grass, the feces assume a tinge 
of green. The feces are usuallj^ mixed to some extent with gas 
bubbles, because of gaseous decomposition taking place within 
the alimentary canal, and the presence of these bubbles imparts 
to the feces a froth}' character. The liquid feces are stick}', and 
the tail and buttocks soon become soiled by the adherent dis- 
charges. This constitutes one of the first noticeable symptoms 
of the disease. 



sporadic Dysentery of the New-born 1023 

The evacuations from the bowels are frequent, and the feces 
•are usually expelled with force. When the disease is well ad- 
vanced the feces are highly irritant, the amount of feces ex- 
pelled at a given time is usually very small, and the expulsion 
is accompanied by straining and other symptoms of pain. The 
disease may cause symptoms of colic, as indicated by the whisking 
•of the tail, kicking at the abdomen and looking at the flank. 
The patient becomes weak ; if the disease is very severe, it lies 
most of the time, and when it gets up, it staggers about in a 
very weak manner. The eyes become sunken, the animal very 
listless, and saliva may flow from the mouth. Emaciation is very 
rapid in the severe cases, and the coat is dry and rough. The 
measurement of the temperature is not very reliable, because in 
the weakened state of the animal the anus remains somewhat 
open. Moreover, the frequent passage of liquid feces tends to 
keep the rectal temperature somewhat depressed. 

As usually observed, the principal postmortem change is an 
irritated condition of the gastro-intestinal canal, which is largely 
concentrated in the colon and rectum. In these parts there is 
present a well-marked catarrhal inflammation of the mucous 
membrane, with a greatly increased secretion of fluids and mucus. 
There is usually very marked anaemia and paleness of the tissues. 

The bacteriology of the disease has not been well determined. 
Usually there is a mixed infection. Various forms of micro- 
organisms have been described by different writers, but it has 
not been definitely shown that the disease is due toanj' one alone. 

Causes. Sporadic diarrhea of the new-born depends largely 
upon the abrupt introduction of pathogenic organisms into the 
alimentary canal of an animal which is not inured to their 
presence. The young animal has undergone a sudden transition 
from the uterus of the mother (which, with the placenta, has 
served as a barrier against most infections) to extra-uterine life, 
where it is subjected to the dangers incident to taking into the 
alimentary tract, food which is almost inevitably contaminated 
with microorganisms capable of inducing disease. 

Anything which maj' depress the general strength of the 
young animal, and which may supply a favorable breeding 
ground for the bacteria introduced into the digestive tract, serves 
indirectly to favor the multiplication of the disease organisms. 
If too much food is taken, it over-taxes the digestive powers, 



I024 Veterinary Obstetrics 

and thus invites the occurrence of disease. It is frequently- 
observed that, when young animals are over-fed, and especially 
when they receive their food in too large amounts at a given- 
period, they are liable to suffer from dysentery. Under natural 
conditions, where the young animal is constantly with the 
mother and has opportunity to suck as often as it may like, the 
danger from over-feeding is not very marked. However, if the 
young animal is separated from its mother during long intervals, 
and thus becomes very hungry, it will eat voraciously when op- 
portunity is afforded, and will partake of more milk than the 
state of its digestive organs warrants, thus tending to induce 
digestive disturbances. In mares it is frequently observed that 
the udder is greatly distended with milk at the time that the foal 
is born, and that the young animal shows a voracious appetite, 
attempting to take all the milk present, with disastrous results. 

An improper quality of milk is also dangerous for the diges- 
tive functions of the new-born. When mares or other mothers 
are hard- worked, and especially in warm weather, their milk is 
very liable to produce digestive disturbances in the young ani- 
mal, and all the more so because the foal is usually denied the 
opportunity to suck at frequent intervals, and becomes very 
hungry. Added to this condition, the foal of a work mare is- 
occasionally compelled to follow her upon a long journey, the 
fatigue of which favors the occurrence of dysentery, and greatly 
aggravates the disease when it already exists. 

The adaptability of the food to the new-born is highly impor- 
tant. New-born animals sometimes show a depraved appetite,, 
and soon after birth partakfe of food which they are not compe- 
tent to digest. In one instance we found upon post mortem ex- 
amination, in a case of fatal diarrhea in a foal three or four days- 
old, a tangled mass of straw in the stomach, weighing perhaps half 
a pound, incapable of digestion or of escaping from the organ 
through the pylorus, and acting as an irremovable irritant. It 
is very common to observe foals habitually swallowing bedding 
and other forms of rubbish or indigestible substances. It is a 
very common experience, when examining the feces in a case of 
scours, to find mixed with the intestinal discharges, undigested 
particles of straw or other similar substances. The eating of 
hay by very young animals frequently acts as a cause of persis- 
tent dysentery. 



sporadic Dysentery of the Neiv-bor7i 1025 

Decomposing foods constitute a fertile source of diarrhea, and 
the disease is consequently very largely seen among young ani- 
mals which are artificially reared. Milk which has been allowed 
to partially decompose, which has begun to ferment or sour, is 
always dangerous as a food for the new-born ; but even more 
dangerous is food which is contaminated with filth. In many 
instances the vessels, from which artificially-reared animals are 
fed, are exceedingly filthy and dirty, and contain particles of 
milk which have been allowed to remain and decompose day after 
day. 

Prognosis. The prognosis of sporadic dysentery in new-born 
animals is usually favorable. In those animals in which the 
disease appears very early, within two or three days after birth, 
the prognosis is less favorable than in those in which the attack 
is delayed until the animal has acquired some age and strength. 
The prognosis necessarily depends somewhat upon the cause of 
the disease, and the power of the veterinarian to overcome it. In 
such a case as that to which we have above referred, in which 
the animal had swallowed a large amount of straw which had 
become molded into a tangled mass in the stomach and was 
neither removable nor digestible, the termination could not be 
other than fatal. 

Handling. The prevention of sporadic dysentery in young 
animals is highly important. The food of the new-born animal 
should be as free as possible from pathogenic organisms, should 
be allowed in proper amounts and at sufficiently frequent inter- 
vals, and should be as readily digestible as circumstances will 
permit. If the young animal is allowed to suck the mother, it 
should be given such opportunity quite frequently ; at first the 
young animal should be allowed to be with its mother constantly. 
If the amount of milk in the udder is excessive, a portion of it 
should be withdrawn, so that the young animal will not be 
tempted to over-feed. This is especially true of the foal, 
since the mare sometimes has an enormous quantity of milk 
when the foal is born, and the latter is so voracious that it may 
greatlj' overfeed, if not prevented by the timely withdrawal of 
a portion of the milk. The objection has been interposed that 
the withdrawal of the milk removes the colostrum, which some 
have alleged is essential to the well-being of the young animal. 
65 



I026 Veterinary Obstetrics 

How true this may be, has not been definitely shown, but it is 
certainly true that many animals are well raised without having 
access to the colostrum. In many mares the milk has been 
flowing freely from the udder for days or weeks before the foal 
is born, and the colostrum has already escaped. Yet, so far as 
we have clinically observed, the foal does not suffer from this 
cause. 

When young animals are to be artificially reared, the task 
should be undertaken with a practical understanding and appli- 
cation of the rules of aseptic feeding. The food should be given 
frequently, and in small amounts, in harmony with the undevel- 
oped state of the alimentary tract, and it should be as free as 
practicable from decomposition and from filth bacteria. The 
vessels from which the milk is fed to the young animal should be 
regularly cleansed and sterilized by boiling before each feeding. 
In some instances it may be desirable to Pasteurize the milk be- 
fore it is fed to the young animal, but this process reduces the 
digestibility of the milk to a degree, and is undesirable except 
in those cases where dangerous pollution cannot otherwise be 
avoided. 

The composition of the food should resemble as closely as pos- 
sible the normal milk of the species of animal to which it is being 
fed. When a young animal is being reared artificially, the milk 
should preferably be derived from an animal of its own species. 

The surroundings of the new-born should be scrupuously clean, 
and there should be a careful avoidance of any dangerous sub- 
stances which are likely to be swallowed. If the young animal 
exhibits a morbid appetite, such as a tendency to eat bedding, it 
is highly important to appl}^ effective preventive measures. In 
som,e instances the young animal shows a marked tendency to eat 
fecal matter which has been voided by itself or other animals. 
The eating of bedding may be largely overcome by removing it 
and keeping the animal upon a bare floor, or still better, when 
the season and surroundings will permit, by placing the animal 
upon clean grass. In other cases, where the morbid appetite is 
marked and serious, we have found it necessary to apply a muzzle 
to the j'oung animal so that it could not swallow rubbish. 

When the disease has become established, the precautions 
above suggested should be rigidly enforced, and in addi- 
tion, measures should be taken to remove, from the alimentary 



sporadic Dysentery of the New-borji 1027 

canal, indigestible and irritant substances, allay the irritation 
in the parts, and disinfect such contents as may remain in the 
canal. First of all we strongly recommend the administration 
of an oleaginous cathartic, such as castor, linseed, or cotton seed 
oil. To the foal may be given one tablespoonful of castor oil, or 
two to three ounces of linseed or cotton seed oil. The oil is ad- 
ministered to gently evacuate the intestinal canal of its irritating 
contents, and at the same time to bring about a soothing of the 
irritated mucous membrane. 

Many practitioners have proceeded in an opposite direction, 
and have administered opium, tannin, catechu, alum and other 
astringent substances, which tend to retain within the canal the 
irritant substances which contain or bear the infecting agents. 
We have not been able to observe the benefits from this class of 
drugs, which have been claimed for them by many writers. 

The disinfection of the alimentary canal, after the removal of 
the infecting discharges so far as practicable, should receive close 
attention upon the part of the practitioner. Many drugs exert 
either a direct or an indirect influence upon micro-organisms in 
the digestive canal. Since the discharges are usually acid in re- 
action, many practitioners have strongly advised the use of alka- 
line carbonates, such as chalk or sodium bicarbonate. Others 
have had excellent results by the administration of powerful 
antiseptics, like corrosive sublimate or carbolic acid in appro- 
priate doses. Indirectly, excellent results have been obtained 
by the adminiscration of small doses of calomel, which, by ex- 
citing the functions of the liver, cause an increased amount of 
bile to be poured into the intestines, which acts as an antiseptic, 
increases the peristalsis of the bowels, and causes the expulsion 
as well as the destruction of the micro-organisms. Salol and 
other similar drugs have been used and recommended by some. 

Stimulants and carminates have also been used and highly 
commended by many practitioners. We have largely used the 
tincture of ginger, with apparently good results. Any of the 
carminates or aromatics may perhaps be used with beneiit. 
Some of them have a direct antiseptic influence, while indirectly 
they all tend to disinfect the alimentary canal by arousing the 
normal peristalsis and secretions of the intestines, which in 
themselves control to a great extent the question of infection. 
There are probably few disinfectants which are superior in effi- 



I028 Veterinary Obstetrics 

ciency to the normal peristalsis of the intestines and the corre- 
lated normal secretions of the alimentary glands. Stimulants 
strengthen the animal and help tide it over a crisis in the course 
of the disease. Alcoholic stimulants act also as antiseptics. 

Much good may sometimes be had from the administration of 
gruels or other substances which are at once nutritive and sooth- 
ing to the irritated mucosa. For this purpose one may use a thin 
gruel of elm bark or of starch, or may administer the whites of 
eggs, but care should be taken not to force too large an amount 
of these substances upon the young animal unless the conditions 
warrant us to believe that they will be digested, and not decom- 
pose to further coinplicate the disease. 

It is desirable to overcome as far as practicable the tenesmus 
due to the irritation by the intestinal discharges in the rectum, 
for which purpose one may advantageously administer enemas 
of a soothing and aseptic character, such as a 0.5% solution of 
carbolic acid in starch or milk. Enemas of elm bark gruel, to 
which has been added salicylate of soda, may be used advan- 
tageously. 

The surroundings of the young animal should be clean and 
comfortable, and any exertion upon its part should be carefully 
avoided, since this tends to greatly aggravate the disease. 

b Infectious Diarrhea of Calves. 

There occurs frequently in calves a serious dysentery or scours, 
which is regarded as a specific infectious disease, differing mate- 
rially from the sporadic dysentery of the young animal. It ap- 
pears usually during the first few days after birth, but may appear 
almost immediately after birth, and, in fact, seemingly exists in 
some instances at the time that the young animal is born, so that 
it quickly perishes from the disease without having sucked the 
mother. The disease is highly fatal, and runs a very acute 
course. 

Causes. Franck was one of the first to describe diarrhea as 
an infectious disease, since which time many writers have verified 
his conclusions, that it is a highly contagious malady due to a 
specific cause. 

Nocard asserted the identity or close relationship between in- 
fectious abortion and dysentery of the new-born, but there seems 
to be no very good clinical grounds for such an assumption, 



Infectious Diarrhea of Calves 1029 

though the possibility of the co-existence of the two maladies in 
one herd cannot be denied. Nocard believed that the infection 
usually enters the body of the calf through the umbilic cord, and 
consequently may occur during the passage of the fetus through 
the birth canal. It has been shown by Walther Schild that new- 
born animals have bacteria in the alimentary tract prior to the 
ingestion of food. 

Jensen does not accept the views of Nocard, but inclines to the 
belief that the infection is usually transmitted directly to the 
alimentary canal through the mouth, or at least that it may be 
so transmitted. Jensen found oval bacteria in pairs or short 
chains, in the mesenteric glands, spleen, liver, kidneys, heart, 
lungs and elsewhere. The organism is apparently closely allied 
to the bacterium coli com?nunis and bacillus fctidi lactis. The 
findings of Jensen have in the main been verified by other 
investigators. He induced the disease experimentally, by admin- 
istering a culture of these organisms, with milk, to calves of sus- 
ceptible age. 

Symptoms. The symptoms of the disease appear usually in 
from one to two days after birth, but in some instances within a 
very few hours. The first symptom observed by the owner is 
usually tenesmus, accompanied by fluid evacuations which are 
at first of a yellowish color and stinking. At first the liquid 
feces are expelled with considerable force, but later the intestines 
largely lose their power and the evacuations take place involun- 
tarily, while the color changes from the normal yellow to a gray 
or whitish-gray, and becomes very thin. The young animal 
ceases to take food, and rapidly becomes weak and dull, with 
cold extremities. The course of the disease is usually very rapid, 
and death follows in from 12 to 48 hours. According to Fried- 
berger and Frohner, the mortality ranges from 80 to 100%. 

Sometimes the disease is accompanied by stretching, and at 
other times convulsions are present. In those cases where the calf 
sickens within a very few hours after birth, before it has sucked, 
the course is very rapid and fatal. This fact has supported the 
opinion of Franck and Nocard, that the infection occurs during 
the intra-uterine life of the calf or at the time of birth while the 
fetus is passing through the vagina. Upon similar grounds 
Friedberger and Frohner are of the opinion that infectious 
uterine catarrh (granular venereal disease?) of the mother may 



1030 Veterinary Obstetrics 

become transferred to the alimentary tract of the fetus and induce 
the diarrhea. 

Thus, according to one and another investigator, a relationship 
is suggested between several more or less serious maladies — abor- 
tion, diarrhea, uterine catarrh. At the present time the writer 
is handling a herd for severe granular venereal disease, in which 
abortion and diarrhea co-exist, but the relationship of the diar- 
rhea to the granular vaginitis is not clear. 

Upon post-mortem examination the chief changes are found in 
the alimentary canal and in the heart. The digestive mucous 
membrane is injected and hemorrhagic, and in some places shows 
a denudation of epithelium. The irritation is largely concen- 
trated in the rectum, where the mucous folds are excessively 
hyperaemic. The mesenteric glands are enlarged and infiltrated, 
as are also the liver and kidneys. The spleen is apparently 
normal ; the heart at times shows ecchymoses. In addition to 
these changes, there are present at times small areas of pneumonia. 

Handling. The therapeutics of this disease has constantly 
proven unsuccessful, and the chief attention is necessarily turned 
to preventive measures. More than a quarter of a century ago, 
Franck advised that pregnant cows be removed from infected 
stables four to six weeks prior to parturition, and that they be 
placed in clean and disinfected stalls. Others have advised that 
the posterior portions of the pregnant animal, the vulva, peri- 
neum, tail and buttocks, be carefullj' disinfected, that the vagina 
be irrigated with warm antiseptics shortly prior to parturition, 
and that the udder be washed with a 2 % carbolic acid solution 
before permitting the calf to suck or before drawing milk from 
the udder to feed the calf. Morkeberg succeeded in reducing the 
mortality from 77 to 33%, by applying careful disinfection, fol- 
lowed by the immediate removal of the calf and feeding it upon, 
clean milk. The udder was carefully washed with corrosive sub- 
limate solution before the milk was drawn for feeding the calf. 

Nocard advises that the navel cord should be ligated and ex- 
cised, and the stump carefully disinfected, because he believes 
that the disease is largelj' transmitted through the wound of the 
ruptured cord while the calf is passing through the vagina or 
while the freshly ruptured cord is yet in contact with, or moist- 
ened by, the vulvo-vaginal fluids. While we admit the proba- 
bility of the transmission of the disease through the navel wound^ 



hifectious Diarrhea of Calves 1031 

it would certainly be unfortunate to ignore other even more 
probable avenues of infection. 

If the infection exists in the genital passages of the mother, it 
mayas readily gain the lungs and alimentary tract by entering the 
nostrils and mouth as it may enter the system through the umbliic 
wound. It is therefore quite as important to guard these portals of 
entry, as it is the umbilic stump. Assuming the correctness of the 
view that the infection is already lying in wait in the genital 
canal when birth begins, antiseptic irrigations of the vaginal 
canal of the cow just prior to labor, and the immediate disinfec- 
tion of the nostrils and mouth of the new-born are indicated. As 
we have already indicated on page 561, we very greatly prefer, 
and strongly recommend, the application of dessicant antiseptic 
powders to the freshly ruptured navel, and would omit the 
ligature. We regard the dessication of the navel stump as more 
efficient, convenient and economic. Apparently those who advise 
ligation of the cord desire that it shall be done prior to rupture, 
but the cord of the calf is so short that it usually ruptures at the 
moment of expulsion, and immediately encounters the most crit- 
ical exposure in its history, if we accept the theory of intra- 
vaginal infection. A ligature, encircling the now dormant cord 
and presumably infected stump, cannot act as a barrier to the 
spread of the infection, but it may readily favor the extension of 
the infection in the necrotic stump by retaining the included 
Whartonian gelatin. 

The calf should at once be removed from the cow and from the 
infected stable. The removal is to be followed by the rigid appli- 
cation of the general rules of asepsis and antisepsis. These must 
include clean and comfortable quarters for the new-born, and 
strictly clean milk in proper quantity and at proper intervals. In 
applying these rules, the milk must be withdrawn from the cow 
under the strictest possible precautions to avoid its contamina- 
tion. Before the milk is drawn, the milker should carefully dis- 
infect his hands and the udder of the cow. The milk should be 
drawn in a sterile vessel. Ample precautions are to be taken 
against contamination of the milk between its withdrawal and 
feeding to the calf. The feeding vessels must be handled under 
strict aseptic precautions, being sterilized before each feeding. 
Care must be taken also that the infection shall not be borne to the 
susceptible young by intermediary bearers, such as caretakers, 



1032 Veterinary Obstetrics 

-afifffials, bedding or food. When the disease exists in a stable, 
it is of great importance that all fecal and other excreta from 
the diseased calves shall be promptly disinfected. The buttocks 
and other soiled parts should be cleansed with a reliable disin- 
fectant, and the soiled bedding and floor should be given close 
attention. 

When the young animal has once become infected, the case is 
almost hopeless. Various antiseptics have been used and recom- 
mended, such as the tri-chloride of iodine, creolin, carbolic acid, 
salicylate of soda and others. Opium has also been used and 
recommended, in conjunction with powdered rhei radix. Opsonic 
and serum prevention and cure have been proposed, but at 
present do not warrant any relaxation in disinfection. 

c. Septic Pleuro-pneumonia of cai,ves. 

Under the name of septic pleuro-pneumonia, Poels has des- 
cribed a fatal disease of calves, complicated bj^ inflammation of 
the pleura and lungs, and caused by specific bacteria which be- 
long to the colon group. Poels secured pure cultures of the 
bacteria, which caused a disease in experiment calves that could 
not be clinically distinguished from that in calves which had ac- 
quired the infection in the natural way. The artificially-grown 
bacteria also killed mice, rabbits and guinea pigs, and induced in 
swine a disease which appeared very much like swine plague. 
The bacteria were found, upon post-mortem examination, in the 
blood and internal organs, and in the pleura and pulmonary exu- 
dates. It is believed that the infection may enter through the 
alimentary tract, the navel, the respiratory organs, or wounds 
upon the body surface. 

The clinical and bacterial differentiation between calf dysen- 
tery and pleuro-pneumonia in calves is not yet clear. Some hold 
the two for identical ; others consider them as distinct diseases, 
due to wholly distinct micro-organisms. 

It is common in outbreaks of calf pleuro-pneumonia, to observe 
diarrhea. In some outbreaks of pleuro-pneumonia, diarrhea is 
the rule rather than the exception. 

The reverse is equally true. Pleuro-pneumonia is b}' no means 
rare in outbreaks of infectious dysentery. Certainly the two 
may coexist. While the evidence for and against the idenity of 



Calf SepticcBviia I033 

diarrhea and pleuro-pueumonia is very confusing, their mode of 
origin, avenue of infection, prognosis and handling are essen- 
tially the same. 

Poels recommends that calves suffering from pleuro-pneumonia 
or diarrhea should be fed upon sterilized milk, from vessels which 
have been sterilized by boiling, and that great care should be 
taken to avoid infection passing to the young animal through the 
medium of dirty milk. Especially he recommends that great care 
should be taken in those cows in which there is a septic dis- 
charge from the vulva, which may thence be transferred to the 
udder and gain entrance into the milk, and suggests that in all 
such cases, the parts which are liable to be soiled, including the 
tail and udder, should be thoroughly disinfected. He further 
suggests that the navel should have antiseptic handling at the 
time of the birth of the young animal. 

d. Calf Septicemia. 

Jensen has described a fatal disease of calves occurring in 
Denmark, which is caused by ovoid bacteria, closely resembling 
those of swine plague, but in their pathogenic properties exhibit- 
ing spme characteristic differences. Jensen considers this disease 
closely allied to the pleuro-pneumonia described by Poels, but it 
runs a more rapid course, without producing inflammation of the 
lungs. In Jensen's observations the calves died in from 12 to 
24 hours after the first appearance of the disease. The calves 
were attacked very suddenly, and became at once so weak that 
they could not stand, the temperature became elevated to about 
41 C, and the patients quickly perished, with symptoms of 
diarrhea and dyspnoea. 

Upon post-mortem examination, Jensen found acute fibrinous 
inflammation of the pleura 'and pericardium, with ecchymoses 
in these two membranes, gastro-enteritis, enlargement of the 
spleen, and infiltrations about the larynx and pharynx. 

e. BacteriEmia of Thomassen. 

Thomassen has described a fatal infection of calves due to a 
bacillus of the colon group, which he could"distinguish from the 
bacterium coli coinniit7iis only by its greater virulence. He con- 
sidered the infection even more virulent than that of diarrhea. 
According to Thomassen the calves are born sound, and show 



I034 Veterinary Obstetrics 

the first symptoms of the disease within from 5 to 8 days, or 
even more, when they suddenly become weak and listless, remain 
recumbent, and, when they are compelled to get up, habitually 
stretch themselves. 

Along with the dry muzzle, the respirations are increased to 
50 or 120 per minute, the pulse is small, 100 to 150 per minute, 
and the temperature is elevated as high as 42° C. Some of the 
patients cough. The appetite is greatly diminished, though the 
calf may continue to drink some milk. In these outbreaks 
diarrhea is rare, and usually the feces are normal, while the 
urine is frequently voided in small amounts and contains epithe- 
lium from the bladder and tubular casts from the kidneys. 
In some cases cerebral symptoms are present, in the form of 
tonic and clonic spasms, to be later followed by paralysis. 

The disease has a duration of 5 or 6 days, and in the experi- 
ence of Thomassen is uniformly fatal. 

The pathologic anatomy consists chiefly of great enlargement 
of the spleen, which is 5 to 6 times its normal size and has a 
weight of about 500 grams. The pulp of the spleen is congested 
and chocolate color or black, and it sometimes shows an irregular 
form, being more swollen at one point than another. In smear 
preparations of the spleen, there are found many bacilli. The 
kidneys are affected with a parenchymatous inflammation, and 
the mucous membrane of the bladder shows streaks or spots of 
a brown-red color. The mesenteric lymph glands are enlarged 
and show hemorrhagic spots. The mucous membrane of the 
fourth stomach, and to a lesser degree that of the small intes- 
tine, show numerous dark red petechia. The liver has under- 
gone parenchymatous degeneration. The endocardium is cov- 
ered with red petechise. 

Thomassen administered various antiseptics to the diseased 
animals, such as carbolic acid, eucalyptol, trichloride of iodine,. 
Lugol's solution and others, but without any success. 



NON-INFECTIOUS DISEASES AND DEFECTS OF THE 
NEW-BORN ANIMAL. 

I. Asphyxia of the New- Born. 

Asphyxia is not rare in the new-born, and may proceed from 
a variety of causes. If the mother has suffered from some malady 
which interferes with aeration of her own blood, just prior to 
parturition, the fetus must necessarily suffer in a somewhat simi- 
lar manner. For example, if a mare in advanced pregnancy is 
suffering from pneumonia, hydrothorax, or other disease which 
interferes with her respiration, the foal, during this diseased con- 
dition of the mother, necessarily suffers more or less for want of 
oxygen. 

If for any reason the fetal placenta becomes detached from the 
maternal placenta before the fetus has sufficiently emerged from 
the genital tract to breathe, and parturition is in any way de- 
layed, asphyxia must necessarily result very quickly. Especially 
in the mare, where the adhesion between the fetal placenta and 
the uterus is very slight, the placenta may become partially or 
wholly detached before the fetus is expelled, and may even be 
expelled ahead of the fetus, causing in either case, a fatal 
asphyxiation. 

During parturition, if the fetus moves slowly through the birth 
canal, especially when in the posterior presentation, and the 
navel cord becomes tightly compressed between the wall of the 
fetal chest and the pelvis of the mother in a manner to interrupt 
the circulation, the delivery must be very quickly concluded or 
fatal asphyxia results. The navel cord may become entangled 
about one of the limbs or the head of the fetus, and the circula- 
tion thus be interrupted. 

In one instance of asphyxiation in pigs, we observed upon 
post-mortem examination a firm clot of mucus occluding the 
glottis and causing, immediately after birth, difficult respiration 
accompanied by dyspnceic sounds. 

It is only rarely that any efforts which the attending veteri- 
narian may be able to exert will successfully overcome suspended 
animation due to asphyxia of the new-born. Usually the asphyxia 
has proceeded too far before the extraction of the fetus, and any 
1035 



1036 Veterhiary Obstetrics 

attempts at resuscitation will prove of no avail. If the heart still 
beats, there may be hope that the asphyxia can be overcome. 
The attendant should attempt to induce artificial respiration by 
such means as are at hand. In some cases, like those related 
above in the pig, there may be present in the larynx a clot of 
mucus, which should be removed. This mncus might be dis- 
lodged by drawing forcibly upon the tongue and then suddenly 
releasing it, and continuing this op.eration as long as may seem 
prudent. In the usual case of asphyxia, respiration may be 
favored by alternately compressing and relaxing the chest with 
the hands, or by extending the anterior limbs alternately forward 
and backward. 

It has been suggested that a tube might be passed through the 
nostril and larynx into the trachea, and amniotic or allantoic 
fluids drawn off which have been inhaled prior to the expulsion 
of the fetus. Such suggestion is based upon an error. If the 
fetus has inhaled amniotic fluid before its expulsion, it will be 
very quickly absorbed from the lungs and will cease to act as an 
impediment to respiration almost immediately, and consequently 
need not be taken into account in any measures for inducing 
artificial respiration. Suspending the asphyxiated young by the 
hind legs tends to stimulate respiration by inducing cerebral en- 
gorgement with venous blood, and incidentally any fluids in the 
lungs may freely escape. 

One of the most efficient means for inducing respiration is the 
alternating electric current, but unfortunately as a rule such ap- 
paratus is not at hand at the critical moment. In many instances 
a sharp blow upon the nose or other sensitive part tends to induce 
respiratory effort. It has also been suggested that dilation and 
irritation of the anus will tend to produce inspiratory effort. 
In a similar manner one may stimulate efforts at breathing by 
dashing cold water upon the skin of the animal. It has also 
been suggested that respiration be stimulated by the inhalation of 
ammonia fumes ; but the efficiency of this plan may well be 
doubted so long as no respiration is taking place, because the 
fumes cannot well be introduced into the nostril except with the 
aid of inspiration. 

It has also been advised that the lungs be inflated by means of 
bellows, applied to one nostril while the other is closed ; but 
this is not necessarily effective, because the larynx may be closed 



Umbilic Hemorrhage 1037 

and the luugs fail to become inflated. If one would be sure of 
the introduction of the air into the lungs, it would be best to in- 
troduce it into the trachea, and close the nostrils and mouth so 
that it could not escape in that way. In some cases, where the 
larynx seems to be occluded and it is impossible to induce free 
breathing through that organ, it might be well to perform 
tracheotomy, until whatever obstruction existing in the larynx 
may be removed. Ordinarily tracheotomy of the newborn involves 
great danger of tracheal collapse later, and is accordingly to be 
avoided as far as possible, and, instead, an incision made through 
the crico-thyroidean liagament large enough to admit the oper- 
ator's finger 

2. Umbilic Hemorrhage. 

Umbilic hemorrhage in the new-born animal is very rare. We 
have not had occasion to observe this accident in any case. 
Under normal conditions, when the umbilic arteries rupture they 
retract within the abdominal cavitj-, as shown in Fig. 56, and in 
so doing withdraw with them, in an inverted manner, the con- 
nective tissue surrounding them, and thus form a net-work of 
fibers, which serves to cause the blood to coagulate and make 
hemorrhage extremely improbable. The retraction of the arteries 
also causes a thickening of their walls, and a distinct decrease in 
their caliber, thereby so narrowing the lumen that it is exceed- 
ingly difficult for blood to escape from their divided ends. In 
addition to this, there is a general physiologic law that the blood 
pressure is decreased whenever the blood is no longer required 
by the tissues. Since the function of the umbilic arteries has 
ceased, the blood pressure within them becomes suddenly de- 
creased. 

Fleming states that hemorrhage may take place from these 
arteries in the foal, because they are firml}' attached to the um- 
bilic ring. After repeated autopsies, we have failed to find 
an instance where such was the case, except the umbilic cord 
had been ligated, and the arteries thereby held so firmly that 
they could not retract. In addition to this, when the cord is 
ligated it is usually divided at an abnormal distance from the 
umbilic ring, so that its retraction is difficult. In all foals which 
we have examined, where the navel cord had been allowed to 
rupture normally, the arteries had promptly retracted to the 



1038 Veterinary Obstetrics 

position shown in Fig. 56, on page 337. Fleming admits that 
this retraction of the artery takes place in the ruminant. The 
only difTerence, so far as we are able to observe, is that the cord 
of the ruminant is so short that it ruptures during birth, and 
ligation is consequently excluded. In the foal, the cord is very 
long and does not spontaneously rupture so promptly. It con- 
sequently affords an opportunity for mischief- making by at- 
tendants, who may so fix the arteries with a ligature that they 
cannot retract. 

Fleming claims that hemorrhage may occur from the umbilic 
vein in ruminants, because of the presence of the ductus venosus, 
although why this should predispose the animal to the accident 
is not made clear. Zundel claims that in some individuals a 
predisposition to umbilic hemorrhage exists. Fleming alludes 
to the possibility of hemorrhage occurring from the umbilic cord 
when the animal is several days old. Perhaps in this case he is 
dealing with secondary hemorrhage due to an infection of the 
artery, probably as a result of ligation of the cord without 
proper antiseptic precautions. It is claimed also that hemor- 
rhage may be caused by the umbilic cord rupturing too close to 
the umbilic ring, though why this should be so does not appear. 

A neighboring veterinary practitioner related a case to us of 
fatal umbilic hemorrhage in a foal, in which case the cord had 
been ligated and later excised. So far as could be determined, it 
seemed that the hemorrhage was the indirect result of the liga- 
tion. The artery had been caught and held by the ligature, 
but, since it was not bound sufiiciently tight to prevent hemor- 
rhage, remained stretched. The blood pressure was probably 
increased because of the ligation. 

Whatever the cause of umbilic hemorrhage, such cause needs 
be removed if possible, in order to control the escape of blood. 
If the cord is too long, and perchance has been ligated, it should 
be divided at the proper point by scraping or tearing. In the 
foal, the point for division is about two to three inches from the 
umbilic ring. After the division of the cord, the Whartonian 
gelatine is to be pressed out and the arteries permitted to retract 
into the abdominal cavity, when hemorrhage must necessarily 
cease. If for any reason the artery does not retract, it should 
be separated from the surrounding tissues and carefully ligated 
under antiseptic precautions. Should hemorrhage from the 



Persistent Urachus 1039 

umbilic vein occur, it is advisable to search for the vessel and 
place a ligature about it. The ligation of the cord itself, as 
advised by some, is not sufficient, because the arteries or vein 
may not be included, as they may have broken at a point higher 
than that at which the ligature is applied. In such cases liga- 
tion would tend to favor, rather than prevent the hemorrhage, 
because it would simply prevent the blood from escaping from 
the amniotic covering of the cord, which has been converted into 
a sac by the ligature, and must eventually become filled with 
blood, causing the ligature to be pushed off. 

In a general way we may best avoid umbilic hemorrhage by 
permitting the cord to rupture spontaneously, or by rupturing 
it at the proper point by linear tension, laceration or ecrasement. 
We should avoid dividing the cord by cutting. 

3. Persistent Urachus. 

Prior to the birth of the young animal, in all those which 
have an allantoic sac, the urinary bladder has two openings, one 
posteriorly through the urethra into the amniotic cavity, and the 
other anteriorly through the umbilic ring and urachus into the 
cavity of the allantois. 

At the time of birth the narrow anterior canal, constituting a 
part of the umbilic cord, becomes ruptured, and under normal 
conditions behaves similarly to the umbilic arteries, and retracts 
with, or is retracted by the arteries, into the abdominal cavity. 
Thereafter the urine can escape only through the urethra. Some- 
what rarely the urachus remains open after birth ; how rarely 
is not clear. We have not personally observed this condition. 
It is probably very rare. 

A more common condition is the re-opening of the urachus in 
cases of umbilic infection, owing to a destruction of the tissue 
which has occluded the ruptured end of the canal at the time of 
birth. This condition we have observed only in the foal. Flem- 
ing asserts that persistent urachus is most frequently observed 
in the foal, because the vessel is closely attached to the umbilic 
ring and does not become retracted. However, so far as we 
have observed, the urachus retracts promptly when the cord is 
ruptured, and does not protrude beyond the umbilicus except in 
those cases where the cord has been ligated and then excised. 



1040 Veterinary Obstetrics 

Symptoms. The symptoms of perforate urachus may be 
divided into two groups, according to causes. 

1 . In cases where the urachus is for some reason abnormally 
open, or has become in some way abnormally divided, or if the 
meatus urinarius is constricted or absent, the young animal, in 
urinating, discharges a large part or all of the urine through the 
navel. If the urethra is closed, the entire amount must flow 
through the navel ; while, if the normal passage is open, a part 
of the urine may flow from each opening. 

2. When the urachus becomes secondarily re-opened, as a con- 
sequence of umbilic infection, the discharge of urine through the 
navel is not very great in amount, but dribbles away or flows in 
a very small stream during urination, and perhaps oozes some- 
what continuously from the navel, keeping the region soiled, 
moist and fetid. In such cases the navel is inflamed, and may 
be swollen, or the patient may show well-defined symptoms of 
pyo-septhsemia or inflammation of the umbilic vessels. In these 
cases the foal or other young animal has remained apparently 
well for some days after birth, and no discharge of urine from 
the navel has been noted during this period. After infection of 
the umbilicus takes place, perhaps three to five days after birth, 
the dribbling of urine from the navel appears. This condition is 
by no means a rare one in foals, and in our observation has been 
most frequently seen when the cord has been ligated and cut 
long, causing the stump to undergo putrid decomposition and the 
urachus to re-open. 

Handling. The method of handling pervious urachus must 
be based primarily upon its cause. If the opening is present at 
the time of birth, it must be regarded as a menace to the health 
of the patient, because it invites infection of the umbilicus by 
keeping the stump of the cord constantly moist and preventing 
its dessication. If it is due simply to an abnormally large or 
inefficient urachus, it may be closed by applying to the part 
dessicating and astringent antiseptics, which, at the same time, 
guard the umbilicus against infection. 

If the pervious urachus is dependent upon an imperforate 
urethra, the urachus must on no account be closed until the 
urethra has been satisfactorily opened, since otherwise a rupture 
of the bladder or other serious result must necessarily ensue. 

When the urachus becomes re-opened as a consequence of 



Retentioji of the Meconium 1041 

umbilic infection, its handling must necessarily be based upon 
disinfection of the part. If we can accomplish the disinfection 
by means of astringent remedies, we may aid materially in over- 
coming the difficulty. The prognosis in these cases must be 
based upon the severity of the umbilic infection, and follow the 
general prognosis of that malady. 

The prognosis of persistent urachus, in general, must be based 
upon its cause. If due to an imperforate urethra, the prognosis 
will be dependent upon the possibility of overcoming the urethral 
atresia. In one case, recently brought to our notice by a neigh- 
boring practitioner, the urachus was still open in a colt aged' one 
year, and efforts to close it surgically, failed. 

Retention of the Meconium. 

During fetal life there accumulates, in the intestinal tube, a 
mixture of epithelial debris and secretions from the glands con- 
nected with the alimentary tract, especially from the liver, which 
excrement is largely retained within the alimentary canal until 
birth, though some of it is frequently found floating in the amni- 
otic fluid. The appearance of meconium, in color and consis- 
tency, varies somewhat according to species and individual. It 
usually varies in color between yellow and a dark green or 
greenish-black. In most new-born young, the meconium occurs 
as a pasty mass, but in the foal it is frequently hard and dry, 
and moulded into pellets bj' the floating colon and rectum. 
The mass is found chiefly in the rectum and floating colon, but 
may occupy the entire large colon and the csecum. 

Since the meconium in most animals occurs in the form of a 
pasty mass, it is usually promptly expelled by the new-born 
without difficulty, and leads to no complications. In the foal, 
where it is hard and dry, it is not infrequently retained, and 
may induce more or less serious disease, which, if not promptly 
and efficiently handled, may lead to the death of the animal. 

Causes. Some claim that retention of the meconium usually 
occurs in foals which are weak or poorly developed, but this we 
have been unable to wholly corroborate, and have found it in 
foals which to all appearances were strong and vigorous at the 
time of birth, and would presumably have continued so had 
proper oversight been given them at the time. In our expe- 
66 



1042 Veterinary Obstetrics 

rience it has appeared that retention of the meconium is most 
common in foals whose mothers have been kept continu- 
ously stabled and upon dry food prior to parturition. Mares 
which are regularly exercised, enjoy the freedom of the pasture, 
or are judiciously worked, as a general rule give birth to foals 
which do not have difficulty from retained meconium. It has 
been asserted that retention of the meconium is usually caused 
bj' the failure of the young animal to secure the colostrum or 
first milk, but this cannot properly be held, since the condition 
exists at the time the fetus is born, so that the colostrum could 
only act as a curative agent and not as a preventive. 

Symptoms. The symptoms of retention of the meconium 
appear very soon after birth, within 10 to 20 hours, but may be 
so slight as to escape observation by the owner until some time 
later. Usually within 24 hours after birth, very evident symp- 
toms of illness appear, con.sisting fundamentally of intermittent 
colic, with the general symptoms of impaction of the large colon. 
These consist chiefly of stretching, or standing in a position of 
extension, with the hind limbs extended far backward, the 
anterior limbs forward, and the back depressed much as if the 
animal were attempting to urinate ; but the position differs from 
that attitude in that the hocks are not flexed and that there is 
no real effort being made to urinate. A close watch will de- 
velop the fact that there is straining, as if to expel something 
from the abdominal cavity, but the impaction of the hard, dry 
meconium in the rectum prevents its walls from contracting, 
and hence the actions of the foal are wanting in the definite 
symptoms of an attempt at defecation. 

The colic preseat may be of any degree of severity. Usually 
it is quite mild at the beginning. The young animal will look 
at its flank and kick at the abdomen with its hind feet, will lie 
down and roll, and show a strong tendency to attempt to balance 
itself upon its back. After Ij'ing for some time it will get up, 
looking bright, and perhaps go to the teat and feed with an 
apparently normal appetite for a little time. It will then let go 
the teat and resume its stretched condition, perhaps standing in 
this attitude for 10 to 20 minutes at a time, occasionally looking 
somewhat anxiously at its flank ; it may then lie down and roll 
again. Thus the symptoms may change more or less rapidly 



Retention of the Mecotiium 1043 

between the stretching, or rolling as in colic, and the bright 
intervals when the foal again sucks. 

In one instance observed by us, in addition to these general 
symptoms there was a morbid appetite, which led the young foal 
to devour quantities of hay and straw, which added very much 
to the intestinal obstruction. 

The symptoms above related are characteristic, and in them- 
selves are well-nigh diagnostic, especially the peculiar stretching 
with the dropping of the back when the animal is standing. In 
almost all cases the diagnosis can be readily and completely veri- 
fied by inserting the index finger into the anus, where the hard 
pellets of meconium are readily felt and recognized. 

In foals, especially those of value, the caretaker should observe 
the new-born animal closely, and see that the meconium is ex- 
pelled within an hour. Should such expulsion not occur, the 
caretaker should at once take measures to bring it about. The 
best means for this is enemas of warm water, to which some soda 
bicarbonate or i % of common salt has been added. Solutions 
of soap or other irritants should be carefully avoided, as they 
cause straining b}^ the pain which they induce. It is not strain- 
ing that we wish to accomplish hy the enema. Instead, it is de- 
sired to soften and macerate the dry pellets so that they will be 
easily expelled, and to this end it is important that only a small 
amount of a bland liquid shall be gently introduced into the 
rectum at a given time. We have usually found that one pint 
of the liquid at a time is ample, and sometimes even less should 
be used. The amount should be so gauged that the little patient 
will not throw it out immediately, but that it will remain in the 
rectum for some time in order to accomplish the maceration 
desired. 

Care should be taken, in administering enemas, to avoid in- 
juring the anus or rectum. It is especially desirable to avoid 
using a large metallic or wooden nozzle upon a syringe, because 
when the intestine is so firmly impacted with dry pellets of me- 
conium there is constant and serious danger of the rigid nozzle 
gliding to one side and rupturing the intestinal wall, inducing a 
fatal lesion. It is preferable to use some other apparatus than 
the ordinary enema syringe. A very convenient implement is 
the ordinary bulb sj^ringe, or the fountain syringe used in house- 
holds. Sometimes it is desirable to introduce the enema deeply 



I044 Veterinary Obstetrics 

into the intestine. For this purpose an ordinary soft rubber 
horse catheter may be passed into the intestine as far as possible, 
and the end fitted upon a syringe, or a small funnel may be in- 
serted into the catheter and elevated sufficiently that fluid poured 
into the funnel will gravitate into the intestine. If the catheter 
is used, it may be possible to pass it gently along the wall 
of the intestine, and, by keeping the fluid flowing through it, 
to push it beyond the pellets of meconium, so that the fluid is 
deposited behind them, insuring their being forced out at the 
first expulsive effort. In some cases we have supplanted the 
normal salt solution or soda bicarbonate solution with warm cot- 
ton seed, olive, or raw linseed, oil. 

Complementary to the enema it may be advisable to admin- 
ister cathartics. The choice of cathartics may vary with cir- 
cumstances. If the case does not seem at all urgent, a bland oil 
is the best. An ordinarj' foal may be given 2 ounces of castor oil, 
or 4-ounce doses of raw linseed, cotton seed, or olive, oil. In 
other instances the practitioner may not feel disposed to await 
the slow action of oil, and may resort instead to the hypodermic 
cathartics in small doses, such as eserine sulphate or arecoline 
in doses of 1-20 to 1-12 grain, which maj' be repeated in 30 to 45 
minutes. 

But with all this treatment, if the case has been neglected, it 
may be impossible to dislodge the pellets. They may be tightly 
impacted for a considerable distance along the rectum and float- 
ing colon. In one neglected case in our clinic, we could recog- 
nize the pellets of meconium, which completely blocked the rectum, 
at a distance of 12 inches from the anus. The hard pellets could 
be clearly felt with an ordinary gum horse catheter. The liquids 
injected directly against the obstruction were all to no purpose. 
Eserine failed to cause the expulsion of the meconium. The 
foal eventually perished, apparently from toxaemia, since there 
was no enteritis present upon post-mortem examination. The 
conditions presenting themselves upon post-mortem examination, 
in this one case, suggested that, had we performed laparotomy 
and gra.sped the intestine, the pellets of meconium could have 
been pushed backward and finally forced out, or the intestine 
might have been opened and the pellets thus removed. But, in 
our experience, if the case has prompt attention no such opera- 
tion is demanded, and ordinarily the case is easily handled. 



Retention of the Meconium 1045 

Some practitioners have devised and recommended meconium 
extractors, such as shown in Fig. 150, with which they have 
claimed good results. In default of these, a wire loop could be 
tried. We have observed but the one case which could not be 
relieved by enemas and oil. 

Fig. 150. 
Meconium Extractors. 

a, Meconium extractor of Masch. 

b, Meconium extractor of Mensik- 
Babolna. 

In the handling of retention of the meconium, it is important 
always to determine when the difficulty has been fully and com- 
pletely surmoimted. The expulsion of more or less meconium 
does not indicate that the difficulty has been completely overcome. 
The full accomplishment of the object has been only certainly 
attained when all the pellets have come away and there has been 
expelled some soft, pasty meconium. Whether looking at the 
affection from a preventive or a curative standpoint, our efforts 
should not be relaxed until we are fully assured that all pellets 
of meconium have been expelled. 



ANATOMICAL DEFECTS OF THE NEW-BORN. 

In tracing the history of the development of the embryo and 
fetus, we have had occasion to remark the occurrence of devia- 
tions from the normal course of development, which serve to 
render the animal abnormal at the time of birth. In many of 
these cases the aberration from the normal is so great as to cause 
what are known as monstrosities, in which case the young ani- 
mals are born so faultily developed that they usually perish im- 
mediately, or if they live, the deformity renders them useless, ' 
and they are consequently destroyed. The consideration of 
these belongs to the domain of teratology, and, as such, are of 
very great scientific interest. 

Quite frequently there exist, in new-born animals, various 
deviations from the normal, insufficient to immediately com- 
promise life, which may be spontaneously overcome, may be cur- 
able by surgical procedure, or may persist, and the animal yet be 
able to perform its functions without very great inconvenience. 

This group of minor deviations should be duly considered at 
the time of the birth, and handled according to the outlook 
for the ultimate value of the defective animal. It should be 
determined whether, by any means, the defect can be over- 
come, and to what extent its persistence will destroy the use- 
fulness of the animal. If it is irremediable, and its persistence 
destroys the value of the animal, it is highly important, in the 
interests of economj^ that the patient should be at once destroyed. 
Still more important is the relation of these defects to the ques- 
tion of hereditary transmission. The majority of them tend 
strongly to become fixed as hereditary defects. Such animals 
show a constant tendency to reproduce their own defects in their 
progen3', even though artificially or spontaneously cured. Such 
animals are consequently unsuitable for breeding purposes. 

These defects accordingly assume a highly important place in 
the breeding of animals, whether viewed from the standpoint of 
surgery or of zootechnics. 

I. Umbilic Hernia. 
ExoMPHALus. Omphalocele. Navel Hernia. 

Umbilic Hernia consists of the non-closure of the umbilic ring 
in the abdominal floor, while the skin closes over the region in 
1046 



Lhnbilic Hertiia 1047 

the normal manner. In tracing the development of the embryo 
on page 558, we noted that the somatopleur folds ventralwards 
and finally unites upon the median line, to constitute the um- 
bilicus, through which normally pass the allantoic stalk, in- 
cluding the allantoic or umbilic arteries and veins, the urachus, 
and the yolk stalk, surrounded by the amnion. 

During the earlier periods of fetal life, the abdominal cavity 
is comparatively small, while the abdominal viscera are so volu- 
minous that there is not sufficient room within the cavity to ac- 
commodate them. They consequently press, or grow outward 
through the wide umbilic ring into the navel cord, so that, in 
fetuses of an early age, a large part of the intestinal mass, 
omentum, and liver, may lie outside the abdominal cavity, lodged 
in the umbilic cord. As the fetus develops and approaches ma- 
turity, the abdominal cavity increases in size, while the umbilic 
ring gradually contracts, until finally the opening becomes 
virtually occluded and the margins of the ring adhere closely to 
the umbilic vessels. For reasons unknown to us, the normal 
closure of the umbilic ring may not occur, and when the young 
animal is born there persists a variable-sized opening through 
the abdominal floor, usually elongated from before to behind as 
an oval slit, wider at the anterior end. In some cases the open- 
ing is almost circular in form. The diameter of the opening may 
vary from so small a size as to be barely distingui.shable, up to 
six or eight inches. The resulting hernial sac corresponds in size. 

The defect may be present in any species of domestic animals, 
though it attracts the most attention, and perhaps is most fre- 
quent, in foals, pigs and puppies. 

Some writers recognize a congenital and acquired umbilic 
hernia. Only the congenital defect is of interest to us. Some 
writers have claimed that an acquired or accidental umbilic 
hernia may be caused by severe muscular exertion of the new- 
born animal, in running or playing, but we find no records of 
cases in our literature to substantiate the correctness of such a 
view, and have not observed such an occurrence in actual practice. 
We have observed from time to time that umbilic hernise, which 
were comparatively inconspicuous at the time of the birth of the 
young animal, later became more conspicuous, and were in- 
creased in size to such a degree as to attract attention. When 
umbihc hernia exists at the time of the birth, anything which 



1048 Veterinary Obstetrics 

may increase the intra-abdominal pressure, such as severe ex- 
pulsive efforts due to the retention of the meconium, or to con- 
stipation of the bowels, may cause a marked increase in the size 
of the hernial sac. The same increase in size may be caused by 
the allowance of large quantities of bulky food. 

Fleming cites Zuadel and others in support of his belief that 
environment, and especially the character of food, tends to in- 
duce the disease. He believes that the young of animals kept 
upon low and marshy pastures, or subsisting upon soft, luxuriant 
herbage during a rainy season, are especially subject to hernise. 

The majority of writers, with whom we are in full accord, 
consider the defect to be chiefly hereditary. We have repeatedly 
observed the strong hereditary tendency of this defect. In one 
instance a client purchased an imported French draft stallion 
for service in a valuable stud of pedigreed draft mares, in the 
progeny of which, urabilic hernia had previously been unknown. 
The first crop of foals showed about 50% of umbilic hernise. The 
stallion was promptly sold, and umbilic hernia did not recur the 
following season or thereafter. We have noted the same heredi- 
tary tendency among swine, where a farmer has been careless in 
the selection of his breeding animals. In some cases we have 
observed an entire litter of pigs aifected with hernise. It is in- 
teresting to note that, in the pig at least, umbilic and scrotal 
hernia seem to be interchangeable, so that, in a given litter of 
pigs, males may suffer from scrotal or umbilic hernia indiffer- 
ently, or even from both, while the females show only the 
umbilic defect. 

Symptoms. There is present, at the umbilicus, a tumor, 
which may be either spherical or pyriform or may be more or 
less elongated from before to behind. The size of the hernial 
ring varies greatly according to species and individual. In the 
puppy it may be J^ to i inch in diameter ; in the foal i to 6 
inches in diameter. 

The character of the tumor, as revealed by palpation, neces- 
sarily depends upon the contents of the hernial sac, and the 
question of their incarceration or freedom to return into the ab- 
dominal cavity. The contents of the hernial sac usually consist 
of portions of intestine containing liquid feces, or of portions of 
the omentum. Except these become incarcerated, a soft, fluctu- 
ating tumor results, which is usually readily pushed upward into 



Umbilic Hernia 104 9 

the abdominal cavity, rendering the hernial ring easily recog- 
nizable by palpation. Usually there is no pain upon pressure or 
manipulation. If the young animal is turned upon its back, 
the tumor usually disappears spontaneously. If the animal is 
caused to struggle, or its nostrils be closed for a time so as to 
cause severe respiratory effort, or it is made to cough, the hernia 
temporarily increases in size. 

In some cases the intestine occupying the hernial sac may 
contain hard, firm masses of feces, which render the hernia hard 
and firm. Such fecal matter is not readily pushed through 
the ring into the abdominal cavity. 

The contents of the hernia may become incarcerated or strangu- 
lated, and induce thereby symptoms differing very materially 
from those which have already been described. If the hernial 
contents consist of intestines, and strangulation occurs, the 
tumor at once becomes very tense and hard, and is more or less 
enlarged as compared with its previous condition, and the animal 
shows severe pain, expressed by violent colic. The hernia may 
also be sensitive to the touch. 

When the hernial contents consist of omentum, and it becomes 
incarcerated, the tumor becomes tense and indolent, cannot be 
reduced, and induces no pain upon palpation. 

Diagnosis. Though umbilic hernia is not liable to become 
mistaken for other diseases, it should be borne in mind that there 
are possibilities of error in diagnosis. In one instance we at- 
tended an umbilic hernia complicated by the presence of umbilic 
fistula from infection at the time of birth. The enlargement 
present was attributed to the chronic infection alone. In opening 
the fistula we punctured the peritoneal wall of a small hernial 
sac, and caused a prolapse of the omentum. Abscesses may 
occur at the navel as a result of infection, and may lead to diag- 
nosis of hernia, but the abscess is irreducible, and may readily be 
tested, in cases of doubt, by aspirating with a hypodermic syringe. 
It is virtually impossible to differentiate between an uncompli- 
cated hernia of the intestines and hernia of the omentum ; nor is 
the differentiation of any great practical value. Strangulated 
umbilic hernia of the intestines is recognized by the hernial colic, 
the irreducibility of the hernia, and the firm, hard character of 
the tumor. Incarcerated umbilic hernia of the omentum, occur- 



1050 Veterinary Obstetrics 

ring chiefly in pigs, is recognized by the firm, irreducible 
tumor, unaccompanied by inflammation or pain. 

Prognosis. The prognosis of umbilic hernia is favorable. 
Many cases, especially small hernise in foals, recover spontane- 
ously, and the others may be surgically overcome with compara- 
tive certainty and safety. If left undisturbed, umbilic hernise 
rarely become incarcerated or otherwise interfere with the well- 
being of the animal. If the hernial ring is small, when the 
animal develops and the intestines increase in size, they can not 
pass through the opening. If the hernial contents consist of omen- 
tum, when the animal grows older, the omental expanse becomes 
comparatively retracted and no longer reaches the open umbilic 
ring. Although the ring may persist throughout the life of the 
animal, the hernial sac no longer becomes filled and is not notice- 
able. The greatest loss attributable to the defect, is the de- 
creased value of pedigreed animals for breeding purposes, -because 
of the well-marked tendency to transmission. 

Treatment. Umbilic hernise in young animals disappear 
spontaneoush' so often that, in all cases where the hernial ring 
is very small, an opportunity should be given for a spontaneous 
recovery. However, when the hernial ring is large, such a re- 
sult cannot be reasonably anticipated, and it becomes desirable to 
use some means for overcoming the defect, except in those 
cases where the animals are intended for early slaughter, where 
handling may well be ignored in most instances. Before under- 
taking any operative treatment, it is desirable that the young 
animal shall have acquired some age and considerable vigor. It 
is generally preferable to postpone a radical operation until the 
animal is two to four months of age. However, it .should not be 
too long delayed, because as the animal grows larger it is some- 
what more difiicult to handle. When fatalities from an opera- 
tion occur, the loss becomes greater to the owner in proportion to 
the age of the animal. The chief plans of handling include : 

a. Bandages. Many writers have advised the application of 
a bandage or truss for the cure of umbilic hernia, apparently 
somewhat in imitation of the human surgeon. For this purpose 
a wide girth or surcingle is applied about the body, over the 
umbilic ring, and maintained in position by straps or bands. In 
a general way these bandages are similar to the Sohnle appara- 
tus, Fig. 149, page 1019. One or more straps pass forward 



Urnbilic Hernia 1051 

between the fore kgs, and are attached to a band about the neck. 
Along the back, the position of the bandage is maintained by 
a back-strap, which extends forward to the neck-band, and back- 
ward to terminate in a crupper. Bandages or trusses are con- 
structed in great variety, but they all depend upon the common 
principle of compression of the umbilicus in such a manner as to 
push the intestines upward, toward or into the abdominal cavity, 
assuming that, in the meantime, the hernial ring will close and 
retain them there. 

Those who recommend a truss claim that it requires from two 
to three months to effect a cure. Even then it is not perfectly 
clear that a large proportion of the alleged cures may not have 
taken place spontaneously. It is to be constantly remembered 
that the truss or bandage cannot keep the intestine or other 
hernial contents within the abdominal cavity, but can only press 
them upward as far as the bandage pushes the walls of the hernial 
sac, leaving the hernial contents lying in the hernial ring. This 
tends to keep the ring open. If there is a projection upon the 
bandage, by which means the contents are pushed up into the 
abdominal cavity completely, the projecting portion of the ap- 
paratus is pushed into the hernial ring, and, in its turn, keeps it 
open and prevents healing. 

Serious objections to the truss are its expense, when well con- 
tructed, and the long period of time during which it must be 
kept applied in order that it may induce a cure. The apparatus 
requires much careful watching and oversight on the part of the 
owner of the animal, since it needs be readjusted frequently, be- 
cause the abdomen is constantly changing in size according to the 
amount of food taken. A very formidable objection, also, is the 
question of injury and annoyance to the young animal. Its skin 
is tender, and great care is necessarj' to avoid galling and other 
injuries from pressure or friction. 

It must be constantly borne in mind that the veterinarian has 
no such opportunity for the efficient application of the truss as 
has the human obstetrist. The patient of the veterinarian either 
stands with the body horizontal, with the entire intestinal mass 
resting directly upon the hernial ring ; or, when lying down, it 
usually remains in the sternal position with the weight of the in- 
testines still upon the defective part. The human practitioner 
may keep his patient constantly upon the back, so that the ab- 



1052 Vetermary Obstetrics 

domiual viscera do not bear upon the part. When the hernial 
ring is very large, hope of a cure, through the agency of a band- 
age, is virtually excluded from the first. 

b. Topical applications have been used for decades, for the 
cure of umbilic hernia. Various substances have been used for 
this purpose, among which may be prominently mentioned the 
application of the mineral acids, either sulphuric or nitric. The 
intent is to cause dry gangrene of the skin and hernial sac by the 
application of the acid thereto ; and, by causing an intense local 
inflammation with much swelling, to induce closure of the hernial 
ring. For this purpose, sulphuric or nitric acid is applied over 
the hernial sac, by means of a glass rod, until the skin has been 
well saturated and an extensive necrosis of the tissues is assured. 
Prior to the application of the acid to the skin, the hernial sac 
may be shaved or clipped. The acid needs be applied quite lib- 
erally, in order that the death of the skin shall be complete and 
the resulting swelling extensive ; otherwise a cure is not certain, 
or even probable. Lafosse recommends the use of 24 to 32 
grammes of nitric acid, appHed over the whole surface of the 
hernial sac, followed by friction, to be continued for three to 
five minutes. The nitric acid usually needs be applied but once 
in order to produce the desired result, but, if the first application 
fails, it may be reapplied in about 15 days. 

Zundel liighl)' recommends this plan, although he admits that 
it is sometimes followed by accidents, the most serious of which 
is an extensive sloughing of the hernial walls, which finally in- 
volves the peritoneum and permits the intestines to become pro- 
lapsed through the opening. Reynal has seen peritonitis follow- 
ing nitric acid cauterization, and lyafosse has observed tetanus as 
a result. Hertwig prefers sulphuric to nitric acid, and applies it 
in lines with a glass rod, twice daily until four applications are 
made. He sometimes added an application of turpentine and oil 
to the part, in order to increase the amount of swelling and edema. 

Other irritants have been used and recommended in the treat- 
ment of this defect. Like the mineral acids, they are intended 
to induce an intense local inflammation and swelling, by which 
means it is hoped to block up the open umbilic ring. Blisters of 
various kinds act in this way. Some veterinarians have prac- 
ticed hypodermic injections into the walls of the hernial sac, 
near to the hernial ring, of irritants of various kinds, such as 



Unibilic Her7iia 1053 

oil of mustard, concentrated solutions of salt, and spirits of tur- 
pentine. Great care should be taken not to inject the irritants 
into the peritoneal cavity, as such an error would be exceedingly 
dangerous. 

c. Ligation. In umbilic hernia, where the ring is very 
large, there is little if any hope of succeeding by either of the 
previous methods. Consequently some method must be applied 
for bringing the margins of the hernial ring into close apposition, 
and retaining them in contact until they become adherent. This 
usuallj' involves the destruction of the hernial sac. Numerous 
methods have been introduced for bringing this about, one of the 
oldest and crudest of which is the ligation of the entire hernial sac 
at its base, so tightly as to cause its death and sloughing away. 
Such a ligature, if well applied, decreases greatly or closes the 
hernial ring, by the tension exerted upon the walls of the hernial 
sac and the surrounding tissues. For the application of such a 
ligature, the patient is secured upon its back, and the hernial sac 
is firmly grasped. After the contents have been safely returned 
into the abdominal cavity, the sac is drawn up tightly, and the 
neighboring skin and skin muscle are brought together in such 
a manner as to tend to draw the margins of the umbilic ring 
nearer to each other. Then, around the base of the hernial sac, 
a stout ligature is tighty applied. The ligature may consist of a 
strong silk or linen cord, in harmony with the size of the hernia, 
or of an elastic ligature which may act more promptly than the 
others. The latter does not need tightening, because its elasticity 
causes a continuous compression until the tissues become des- 
troyed and the sac sloughs away. If there should appear to be 
any doubt about the security of the ligature, a suture or a 
skewer may be passed through the hernial sac below it, and any 
danger from its slipping thus obviated. 

The results from ligatures have not generally been satisfac- 
tory, and the method has largely fallen into disuse. They are 
uncertain in their action ; they may cause a very tardy slough ; 
the hernia may reform before the sac is completely destroyed ; or 
a very rapid necrosis may occur, resulting in prolapse. 

d. Clamps have been recommended very highly, by some 
practitioners, in the treatment of umbilic hernia. They do not 
differ materially, in their general character, from the clamps 
used in castration, and their application is upon a similar princi- 



I054 Veterinary Obstetrics 

pie. Various types of clamps are listed by veterinary instru- 
ment makers, based upon the recommendation of practitioners 
who have used them and found them satisfactory ; but no one 
possesses any special advantage, and the practitioner may readily 
make clamps from a stick of wood which will answer all essential 
purposes. The clamps are applied essentially the same as the 
ligature. The animal is secured upon its back ; the contents of 
the hernial sac returned into the abdomen ; the sac firmly 
grasped ; and the clamps applied antero-posteriorly, as close to the 
abdomen as possible, and fixed very tightly so as to cut off the 
circulation from the sac and cause its death. 

Two dangers confront the practitioner in the use of clamps. 
Some have found that, as with the ligature, the clamps may 
cause a very rapid gangrene, with consequent early sloughing 
and protrusion of the intestines. In our own experience we have 
found the clamps inefficient. After having applied them as close 
to the abdominal floor as possible, and secured them very tightly, 
we succeeded in producing necrosis and the destruction of the 
entire hernial sac. However, while this was going on the intes- 
tines were constantly pressing through the hernial ring, so that, 
when the sac, which had been included between the clamps, had 
completely sloughed off, it was found, to our disappointment, that 
the weight of the intestines from above had pushed the skin down- 
ward and a new hernial sac had formed, which, though somewhat 
less in size, was just as objectionable as the original defect and 
required further surgical attention. 

If clamps are to be applied, the operation should be carried out 
under antiseptic precautions, the area shaved and disinfected, and 
either general or local anaesthesia induced. The hernial sac is to 
be grasped, drawn out as far as possible, and the clamps applied 
close to the ring, including all the tissues which can be drawn 
into them. The clamps are then to be closed by means of forceps, 
and secured with a cord. An abundance of antiseptic cotton 
or gauze is then to be packed about the clamps and over the in- 
carcerated sac, and over this a strong bandage is to be placed, and 
well secured in position in such a manner that it will hold the 
clamps tightly against the umbilic ring. By so doing, the hernial 
sac is held against the ring, and the inflammation caused by the 
necrosis of the sac induces inflammatory adhesion and closure of 
the hernial ring. 



Umbilic Hernia 1055 

Strict antisepsis should be maintained, and the necrotic hernial 
sac prevented from decomposing or becoming harmfully infected. 
Usually the necrotic sac drops away within seven to ten days. 
The atresia of the hernial ring may be furthered and rendered 
more secure by the continuance of the supporting antiseptic 
bandage 'for a few days after the necrotic sac has dropped away. 

e. Sutures constitute the most radical, and, in our hands, the 
most satisfactory method for handling umbilic hernia. The 
sutures may be applied by a great variety of methods. 

In very large hernise it is best to open the hernial sac freely, 
under general anaesthesia and strict asepsis, and, after denuding 
the margins of the hernial ring, to pass strong sutures through 
the margins of the ring and forcibly draw them together. In 
one instance in our clinic, a yearling filly had an umbilic hernia, 
the oblong ring of which measured approximately 4 by 8 inches. 
The animal was secured in the dorsal position upon the table, 
and anesthetized. With the aid of two assistants, the hernial 
sac was opened from end to end under strict aseptic precau- 
tions. By means of a strong needle, sutures were passed through 
the skin and other tissues into the muscular walls of the abdo- 
men, and then carried across from one margin of the ring to the 
point opposite, where they were finally brought out through the 
skin on the opposite side, some distance from the margin of the 
hernial ring. The suture was then returned in the opposite di- 
rection, at a distance of about % inch, a piece of rubber tubing 
passed between the closed end and the skin, and a second piece 
of tubing laid between the two free ends, which were now tied 
and drawn sufficiently tight to bring the two margins of the ring 
into immediate contact. 

A series of these sutures was applied, sufficient in number to 
thoroughly close the entire hernial ring from end to end, thus 
constituting essentially a quilled suture. The hernial sac was 
excised, and the margins of the skin brought together by ordi- 
nary interrupted sutures. A broad bandage was then passed 
around the body of the filly, and a large antiseptic pad securely 
attached to it, pressing upon the operative area. The pad of 
absorbent cotton was saturated several times daily with i-iooo 
corrosive sublimate solution. There was little reaction from the 
operation, and the suppuration in the wound was trivial in 



1056 Veterinary Obstetrics 

amount. After about two weeks the sutures were removed, and 
the animal was discharged, completely cured. 

In other cases, where the hernia was not so large, we have 
operated by cutting a hole into the hernial sac, through which 
an index finger is passed in order to constitute a guide and insur- 
ance against the wounding of the viscera. A heavy needle, armed 
with a strong suture, is then inserted into the skin at a distance 
of two or more inches to the right or left of the margin of the 
hernial ring, and carefully guided through the abdominal mus- 
cles of the one side, and across the hernial ring, to penetrate the 
abdominal muscles on the other side of the ring, and through the 
skin, to emerge some distance from the hernial ring. The needle 
is then reversed, and thence returned at a distance of about Y^ 
inch from the point of beginning, where the two ends are tied as 
in the preceding case. Other sutures are added until the ring is 
completely closed, as determined by digital examination. 

In small umbilic hernise a modification of this suture has been 
used by us, with very satisfactory results. The animal is secured 
upon its back, and the area is shaved and disinfected. The 
hernial contents are returned into the abdomen, and the hernial 
sac gra.sped with one hand and drawn out as far as possible. The 
hernial sac is then firmly grasped from side to side, between the 
thumb on one side and the fingers on the other, and the walls 
brought tightly together. In small hernise, if as much as possi- 
ble of the skin on either side is grasped in this manner, and the 
two sides brought together, the operation also draws the margins 
of the hernial ring together. A needle armed with a heavy silk 
suture is inserted immediately against the thumb and finger, be- 
tween them and the abdominal floor, so as to avoid any danger 
of wounding the intestine, and is forced through to the opposite 
side as shown in Fig. 151 A. Grasping the hernial sac anew, 
and reversing the needle and inserting it about J^ inch from its 
point of emergence, the operator carries it back to the opposite 
side parallel to the first suture, and ties the two ends together, 
as indicated in Fig. 151 B, so tightly as to close the hernial ring. 

A second suture is now inserted in the same way, at a point 
about ^ inch distant from the first, and the series of sutures is 
continued until a sufiicient number have been inserted to prevent 
the escape of the hernial contents between or beyond the sutures. 
Care is to be taken that at either end the sutures extend beyond 



Uvibilic Hernia 



1057 



the hernial ring, including all of the hernial sac, thus excluding 
the possibility of the intestine slipping out from behind or in 
front of the sutures. By this method the hernial sac does not 
become necrotic, and is not destroyed if the operation has been 
carried out under strict antiseptic precautions. Under this plan, 




Pig. 151. 



Diagrammatic Illustration of Sutures for 
Umbilic Hernia. 



A, Cross section through the hernial ring and sac, showing relations of su- 

ture to hernial parts, i. Peritoneum ; 2, Muscles of abdominal floor ; 3, 
Skin and subcutaneous tissues ; 4, Suture ; 5, Hernial opening. 

B, Diagram of hernial ring viewed from below, with hernial sac cut away 

to show plan of sutures, i. Hernial ring ; 2, Margin of the skin where 
hernial sac has been cut away ; 3, 3, Areas between the sutures in which 
the hernial sac is not strangulated ; 4, 4, 4, Areas in hernial sac which 
are included in the sutures but which still receive a vasciilar supply 
from areas 3, 3. 

according to our experience, the hernial ring closes more surely 
than with strangulation and necrosis of the hernial sac, and any 
risk from rapid or extensive sloughing is excluded. A broad, 
many-tailed bandage is applied around the body, and an antiseptic 
pack is applied over the operative area and repeatedly saturated 
with antiseptics until danger from infection has passed. The 
bandage is kept in place for five or six days, and the sutures are 
left in position for three weeks or longer, when they are to be 
67 



1058 Veterinary Obstetrics 

removed. The hernial sac remains as an empty pouch, but after 
a time this tends to disappear spontaneously, or may be clipped off. 

Others apply sutures in such a way as to constitute essentialh' 
a multiple incarcerating ligature, causing the entire hernial sac 
to become necrotic and slough awaj-. This plan has little if an}- 
advantage over the simple ligature. 

Ligatures, clamps and sutures have the common danger of in- 
fection, which should be avoided by the application of strict anti- 
sepsis. While it is essential that .strict precautions be taken pre- 
liminary to and during the operation, it is just as important that 
the resulting wound be handled according to antiseptic methods. 
Thus, whether we use the ligature, clamps or sutures, an antiseptic 
dressing should be applied to the area of operation, and the part 
should be maintained in an antiseptic state from the completion 
of the operation until danger from infection has been safely 
passed, which is usually after about one week. 

When an intestinal umbilic hernia becomes strangulated, radi- 
cal measures should at once be taken to bring about a cure. It 
is first essential to relieve the strangulation, which may be done 
in some cases by securing the animal upon its back and carefully 
manipulating the hernial contents, so that they may be pre.ssed 
back into the abdominal cavity. This process may be greatly 
favored by general anaesthesia. If the contents of the intestines 
are liquid, the incarceration may be overcome by aspirating por- 
tions of the fluid contents by means of a hypodermic syringe or a 
small trocar, after which the prolapsed intestines may usually be 
readily returned. If these measures fail, the hernia should be 
cut down upon, the ring dilated by cutting, the strangulated 
viscera returned, and the margins of the hernial ring brought 
together by sutures, such as we have described above. 

When there exists a hernia consisting of omentum, and it be- 
comes incarcerated, the death of the strangulated portion pro- 
duces no general symptoms, but the hernial tumor becomes rather 
hard and unyielding. By such means, the hernia becomes sponta- 
neously obliterated, but the tumor remains. This condition we 
have observed in several instances in the pig. The condition is 
not a serious one, and its only significance is the blemish, which 
can readily be removed by opening the hernial sac and excising 
the necrotic omentum, after which the ring and sac are to be 
closed under antiseptic precautions. 



Scrotal Hernia. Inguinal Hernia 1059 

2. Scrotal Hernia. Inguinal Hernia. 

Scrotal or inguinal hernia may exist in an}' new-born domes- 
tic animal, perhaps most frequently in the foal and pig, rarely in 
ruminants and carnivora. Inguinal hernia is virtually a defect 
of the male, though very rarely it exists in the female. As shown 
in Fig. 57, page 338, there exists, early in fetal life, the internal 
inguinal or abdominal ring, through which passes the guberna- 
culum testis from the scrotum to the testicle. Later, as the male 
animal develops, there occurs an evagination of the peritoneum, 
the processus vaginalis, through the inguinal ring into the scrotal 
pouch, and the testicle ultimately descends, until finally the evagi- 
nated portion of the peritoneum forms the external or parietal 
layer of the scrotal peritoneum. 

As already related on page 336, the descent of the testicle 
occurs at a variable period of time, controlled largely b}' species. 
In solipeds and ruminants, as well as in swine, the glands are 
usually in the scrotum at the time of the birth of the young 
animal. In some cases the inguinal ring in the fetus is abnor- 
mally large, and the intra- abominal pressure during early fetal 
life may cause portions of the viscera to be forced out through 
the ring, and, remaining there, prevent the latter from normally 
closing, or narrowing to such a degree as to prevent the escape of 
viscera from the abdominal cavity. In all domestic animals, the 
inguinal ring normally remains pervious throughout life, and 
consequently inguinal hernia does not depend upon the abnormal 
existence of an opening, but merely upon its abnormal size. 

In new-born foals, especially among the draft breeds, scrotal 
hernia is very common at birth, but is usually of a temporary 
character, and spontaneously disappears. However, this does 
not always occur, and in some instances the internal inguinal 
ring is excessively large, so that portions of viscera protrude 
through it, which, by their weight, tend to render the abnormal 
dilation of the ring permanent and to cause the hernia to persist 
throughout the life of the animal unless surgically handled. In 
the pig, scrotal hernia is quite common, and usually tends to re- 
main permanent unless surgical interference takes place. 

The size of the hernial ring shows every possible variation. 
We have observed, in the foal, an internal ring four or five inches 
in diameter, through which virtually all the abdominal viscera, 



io6o Veterijiary Obstetrics 

which were not too closely retained by mesenterj^ dropped out 
into the hernial sac, descending to the level of the hocks. Such 
conditions inevitably persist unless surgical relief is applied, and 
the size of the hernia tends to grow, rather than decrease. It is 
not rare to see a stallion with a scrotal hernia extending down to 
the hocks, and with the internal ring so large that the veterinarian 
may pass his hand throiigh the rectum, into and through the 
hernial ring, covered by the intestine, and down into the scrotal 
sac. The contents of the hernial sac maj' consist of either in- 
testine or omentum. 

The symptoms of scrotal hernia in the new-born are usually 
very apparent, and consist essentiall}^ of an increased size of one 
or both halves of the scrotum. Upon manipulation, it is usually 
found that the herniated intestine or omentum can be readily re- 
turned into the abdominal cavity, especially if the patient is 
placed upon its back. After the contents have been returned, 
the enlarged ring can be discovered by digital exploration. 

Strangulation, or incarceration, of scrotal hernia is very rare 
in new-born animals. We have noted but one instance in a young 
animal, which occurred in a foal, some weeks of age. When 
strangulation occurs, the ordinary symptoms of strangulated 
hernia appear, consisting of severe and constant colic, with 
sweating and trembling. The volume of the hernial contents is 
increased ; the sac is tense, firm and painful. 

The course and termination of scrotal hernia vary, according 
to species and the size of the hernial ring. In most animals 
scrotal hernia tends to persist, and to increase rather than de- 
crease in size, as the patient grows older. In the foal, when the 
scrotal hernia is small, it tends to disappear spontaneously with 
age. In probably 90%, or even more, of foals born with scrotal 
hernia, the defect becomes spontaneously remedied, so far that 
they may be safely castrated by the open operation when one 
year old. The contents of scrotal hernia very rarely, if ever, 
become adherent, except because of some ineffectual surgical 
handling. 

The defect is markedly hereditary, and its existence in the 
young animal serves to render it of diminished value for breed- 
ing purposes. In the foal, it has yet another significance, 
from a clinical standpoint, in that, even though the defect may 
be apparentl3' overcome in a spontaneous manner, it may yet 



Scrotal Hernia. Inguinal Hernia 1061 

lead to serious or fatal accident in later life. If such an animal 
is castrated after apparent recovery, without unusual precautions 
having been taken, protrusion of the omentum, or still worse, of 
the intestine, is liable to occur, and lead to serious or fatal re- 
sults. If the animal is retained for breeding purposes, it may, 
at an)' time after reaching adult life, suddenly develop strangu- 
lated hernia, owing to some accident or exertion which may 
cause a sudden increase of the intra-abdominal pressure, such as 
jumping, rearing, or copulating with a mare. 

Handling. Since scrotal hernia in the foal usually recovers 
spontaneously during the first year, a reasonable opportunity 
for such recovery should be advised. If, however, the hernia is 
very large or tends constantly to increase in size, or if it threatens 
to become strangulated, a radical operation for its cure should 
not be long delayed. The new-born foal is usually wanting in 
the desired vigor to withstand such an operation, and whenever 
practicable the veterinarian should postpone surgical interference 
until the foal has acquired strength and the tissues have de- 
veloped increased powers of resistance. 

The surgical handling of scrotal hernia consists essentially of 
the removal of the testicle, and the closure of the ring or of the 
inguinal canal. The most common and preferable operation is 
that of " covered " castration. The animal is cast and turned 
upon its back. In case of the foal, general anaesthesia should 
be induced. 

Under thorough antiseptic precautions, the skin and dartos 
are incised down to the cremasteric fascia. The testicle is 
grasped, inclosed within the cremasteric fascia and peritoneum, 
and traction exerted upon it, while the dartos is separated from 
the cremasteric fascia and muscle by means of the fingers or 
scalpel handle. The separation is carried upwards to and beyond 
the external abdominal ring. In this manner the two groups 
of tissues of the scrotum are separated from each other. The 
skin and dartos derived from the external body wall, are separated 
from the cremaster and peritoneum, which have been carried 
down from the abdominal cavity with the testicle in its descent. 

A curved needle, armed with sterilized silk, is passed through 
the cremaster and spermatic cord, as high up against the internal 
ring as is practicable. After the needle has been removed, the 



io62 Veteri7iary Obstetrics 

ligature is tied tightly around the entire cord. Having been 
passed through the cord, the ligature is insured against slipping. 

While catgut presents the advantage of being absorbed by the 
tissues, its use is excluded in this operation because it quickly 
softens and relaxes to such a degree as to permit hemorrhage 
from the spermatic arteries, or the ligature slips and prolapse of 
the intestine or mesentery occurs. In one case, where we ligated 
carefully with catgut, severe and dangerous hemorrhage occurred, 
although the ligature remained in position. The cord had to be 
later ligated with strong silk in order to save the patient's life. 

After the ligature has been securely placed about the parts, the 
ligated tissues may be severed with a scalpel, or preferably with 
scissors, at a distance of not less than i inch beyond the point 
of ligation. Great care should always be taken to leave a suffi- 
ciently long stump. The pressure of intestines or omentum 
above tends to pull a portion of the ligated inguinal wall out of 
theligature, even though it has been passed through the cord and 
investing tissues. 

If the hernial ring is comparatively small, the wound through 
the skin and dartos maj'' be allowed to remain open, but we be- 
lieve such a course inadvisable, and would recommend the closing 
of the scrotal wound by means of sutures. If the ring is very 
capacious, and the hernia very large, the cremaster muscle may 
be so much attenuated that it does not offer sufficient strength to 
render the maintenance of the weight of the viscera secure 
against prolapse of the intestine. In order to guard against this, 
it is essential that the scrotal wound be closed. If the sac is 
very large, the ligation of the cremaster and peritoneum, and the 
suturing of the wound of the skin and dartos, may not prevent 
the intestinal mass from breaking through to constitute prolapse. 

As a further guard against the descent of the viscera, a portion 
of the scrotal sac may be removed, after which the suturing of 
the margins of the wound stretches the skin across the external 
abdominal ring and exerts some pressure upon the parts. This 
pressure may be accentuated, and rendered far more efficient, by 
inserting into the external abdominal ring, against the ligated 
stump of the cord and exci-sed cremaster, a large mass of anti- 
septic gauze, so that, when the skin and dartos are brought to- 
gether and sutured over it, a distinct pressure and support is 
obtained. Other means for insuring ample pressure upon the 



hnpcrforate Alius 1063 

part may be used. The skin from the inguinal region may be 
drawn down tightly over the external ring, and sutures passed 
through it and the internal and anterior margins of the ring, so 
that the skin and dartos are thus firmly fixed to the deeper parts, 
and the external abdominal ring virtually closed. Or, with heavy 
silk, the margins of the external abdominal ring may be brought 
together. 

The operation upon the pig is carried out in a similar manner. 
The position of the scrotum in the pig renders it less difficult to 
retain the intestines within the abdominal cavity. 

After the performance of the operation, the patient should be 
allowed quiet and clean quarters. In the case of the foal, the 
parts should be disinfected several times daily, but otherwise 
should go undisturbed except in those cases where a pack of 
gauze or other material has been inserted, as above recommended, 
which should be removed in the course of 48 hours, when a suffi- 
cient swelling will have taken place in the part to prevent the 
prolapse of the intestine. For a time the animal should be fed 
very lightly, in order to avoid distension of the abdominal cavity 
and unnecessary pressure upon the parts. Should the ligature 
about the cord become infected, a fistulous opening may result, and 
necessitate cutting down upon the cord at a later date, and re- 
moval of the ligature. Sometimes the ligature infection takes the 
form of botryomycosisor schirrhous cord, and necessitates the re- 
moval of the diseased cord. 

The age at which scrotal hernise should be operated upon will 
vary according to circumstances. In the foal, unless there 
is some reason to the contrary, such as strangulation, or growth 
of the hernia, it should be postponed until the patient is eight to 
twelve weeks old, but it may be performed at any age when cir- 
cumstances may demand it. In the pig there is little, if any- 
thing, to be gained by delay ; and the animal may as well be 
operated upon at the usual age of castration. 

3. Imperforate Anus. 

In considering the development of the embryo, we have 
learned, on page 310, that at an early period in its history the 
posterior gut ends blindly, and, opposite to it upon the external 
surface, there appears a depression in the ectoderm known as the 
proctodeal pit, which gradually becomes deeper while the wall be- 



1064 Veterinary Obstetrics 

tween it and the end of the gut becomes more and more attenu- 
ated, until finally it disappears and the gut opens posteriorly as 
the anus. In some cases the attenuation and disappearance of 
the walls of the proctodeal pit fail to occur, and as a result the 
young animal is born with an imperforate anus. 

In other cases, not only is there an arrest of the development 
in this part, but the entire posterior gut, or any portion of it, may 
fail to form or may become obliterated early, so that there is an 
absence of both the anus and the rectum. 

The diagnosis of imperforate anus is comparatively simple, 
since it depends upon the absence of that organ. Upon examin- 
ation no posterior opening of the gut is discoverable. If only 
the anus fails, the meconium may be pushed back against the 
thin membrane, to form a tumor in the anal region ; while, if the 
rectum itself is absent, no such tumor occurs. 

The handling of imperforate anus consists of making an in- 
cision through the skin of the part, down upon the accumulated 
meconium. If the rectum is absent, so that the accumulation of 
meconium in the anal region does not occur, the animal should 
be de;stroyed as valueless. 

In some instances in new-born females, there occurs an imper- 
forate anus, accompanied by an imperfect vulvo-anal partition, 
and the feces drop downward into the vulva through the defect- 
ive partition, and escape therefrom involuntarily. Such a case is 
illustrated in Fig. 42 on page 310. It may possiblj' be overcome 
by inserting the finger or a curved sound through the vulva up 
into the anus, and, directing it backward, cutting down in the 
anal region until the wall is perforated. The communication 
between the anus and vulva may then be denuded of its mucous 
membrane, and closed by sutures. However, because of the 
difficulty of bringing about the closure of an opening in this 
place, it would be better as a rule to destroy the young animal, 
unless it is of unusual value for work purposes. An animal with 
such a defect should not be used for breeding. 

4. Imperforate Vulva. 

Imperforate vulva is fundamentally referable to the same cause 
as we have already described as operating in imperforate anus. 
The vulva is formed in the same manner as the anus, that is, it 
originates from the lower portion of the proctodeal pit. The 



Atresia of the Posterior Nares 1065 

atresia or closure may not end with the vulva, but may include 
other parts of the urino-genital canal. If the vulva is com- 
pletely closed, it prevents the discharge of urine through the 
normal channel, and forces it to continue to pass through the 
urachus. 

The handling of imperforate vulva cannot as a rule be suc- 
cessful, because it is difficult or impossible to discover the 
urethra and open it in a manner which will prove effective. The 
animal may continue to live indefinitely with an open urachus, 
but is of no value. When the vulva is only partially closed, and 
there is room for urine to escape readily, there is no occasion for 
surgical interference. As a general rule, such partial atresia or 
absence of the vulva in reality depends upon an asexual state, 
as is observed in freemartins, so that the animal is incapable of 
breeding. Consequently, there is no object to be gained by any 
surgical attempt at dilating the vulva. 

5. Atresia of the Posterior Nares. 

In studying the development of the embryo on page 296, we 
noted that the nasal and oral cavities are at first one common 
chamber, which later becomes divided into two .separate passages 
by the lateral ingrowth and fusion of the palatine plates, which 
eventually become ossified throughout most of their extent, to 
constitute the hard palate. In some cases it is found that this 
partition between the nasal and oral cavities continues backward 
to the base of the sphenoid bone, thus causing a more or less 
complete atresia of the posterior nares. The defect has been re- 
corded in man and in the horse. When involving but one 
nostril, the defect may escape detection, because, unless the young 
animal is caused to undergo severe exertion, the one free nostril 
answers all demands for respiration and no inconvenience ensues. 
If both posterior nares should be occluded, severe dyspnoea re- 
sults, and oral breathing becomes necessary. 

When an animal, with atresia of one posterior naris, arrives at 
a working age, and is put to heavy draft or rapid travel, the de- 
fective respiratory passage becomes at once evident, and a dis- 
tinct roaring noise is present. In one case existing in a three- 
year-old in our clinic, there were no external evidences of dis- 
ease, such as bulging or inequality of the face, no nasal dis- 



io66 Veterinary Obsteb-ics 

charge, no abnormal odor. One posterior naris was completely 
closed, and consequently there was unilateral breathing. A 
sound, passed along the floor of the affected nostril, when it 
reached the posterior naris, passed upward and backward until 
it lodged against the base of the sphenoid bone, instead of glid- 
ing downward and backward into the pharynx. 

The handling of this defect should be undertaken early, or at 
least recognized early, in order to determine whether the diffi- 
culty can be successfully removed or not. If the case is properly 
diagnosed, the prognosis is good. 

By means of a rigid curved sound, the membrane stretching 
across the posterior naris may usually be ruptured. lu opera- 
ting, the occluding partition should be carefully broken down un- 
til free respiration through the nostril is obtained. If necessary, 
the frontal bone may be trephined on a level with the posterior 
nares, and the partition ruptured with forceps, sound or other 
instrument, through the trephine opening. 

6. Atresia of Other Body Openings. 

An imperforate condition of any other body opening may ex- 
ist, but aside from those already mentioned, which are not at 
all common, such conditions in our domestic animals are exceed- 
ingly rare, and are of scientific, rather than practical interest. 

Imperforate prepuce has been described by Brugnone as occur- 
ring in foals. He recommends that the organ be divided, and 
the opening held apart by some suitable contrivance. If such 
an opening is not made, the urine must necessarily be voided 
through the urachus. The operation cannot usually succeed 
unless the atresia involves the prepuce only. If the urethra it- 
self is closed, it is generally impossible to effectively open it. 

Epispadias is a term used to designate a defect in the urethra 
by which it opens upon its superior surface at some point other 
than the extremity of the penis. In other instances the ab- 
normal opening maj' occur upon the inferior surface of the tube, 
and is then known as hypospadias. In such instances there is 
an absence of the urethral canal beyond the point of opening. 

In the majority of cases in veterinary practice, and described as 
epispadias or hypospadias, the condition is in reality an approach 
toward, if not actual hermaphroditism. There are present, in 
varying degrees of development, some parts of both the male and 



J^fsstar of the Palate 1067 

female generative organs. This is especially true in the horse, 
where cryptorchid testicles frequently develop, along with a 
more or less imperfect vagina and vulva, and an erectile organ 
which may occupy an intermediary position between the normal 
clitoris of the mare and the penis of the stallion. 

The handling of these abnormalities will vary according to 
circumstances. Unless by surgical interference the urine can be 
caused to be voided in an unobjectionable direction and manner, it 
is advisable to destroy the young animal at once as being worth- 
less. If there is a well developed vulva, the abnormally long 
clitoris or short penis, as one may prefer to term it, may be 
amputated within the vulva, so that the animal will urinate as 
though a mare. In such cases of hermaphroditism the testicles 
may be removed, when the animal has reached the proper age, in 
the same manner as ordinary cryptorchids are castrated ; or, as 
in one case upon which we operated, the glands may be removed 
through the vagina in the same manner as the ovaries in the 
mare. 

Occlusion of the eyelids sometimes occurs in the new-born. 
In carnivora and rodents the eyelids are normally adherent at the 
time of birth, while in other animals they are open. If the eye- 
lids are adherent merely by their margins, they maj' be separated 
by tension or by carefully dividing them with a scalpel. In 
some cases, however, the lachrymal cavity is wanting and the 
eyelids are adherent to the cornea. In such a case there is no 
help for the condition. In other instances we have observed the 
new-born animal without a cornea, and the sclerotic coat cover- 
ing the entire eyeball. This is not subject to remedy. 

Occlusion of the auditory canal occurs occasionally, especially 
in the dog. It is recorded that in some cases there is a soft 
tumor at the point where the opening of the canal should exist, 
which can be readily seized with forceps and excised with a 
scalpel, exposing an accumulation of cerumen or ear wax, which 
may be removed by syringing out with tepid water. Such ani- 
mals are usually incurably deaf. 

7. Fissure of the Palate. 

Fissure of the palate is a comparatively rare congenital defect 
in the new-born. In our museum, there is one specimen of fis- 



io68 Veterijiary Obstetrics 

sure of the palate, in a colt which lived to about one year old, 
when it was destroyed as incurable. 

The defect consists of an arrest in the development of the 
palatine laminse or arches, which fail to come in contact and fuse 
upon the median line, thus forming a direct opening from the 
mouth into the nostrils, as indicated in Fig. 35 on page 298. The 
fissure permits the passage of food from the mouth into the nasal 
chambers, from whence it drops out through the nostrils. In 
this way the young animal is placed at a serious disadvantage 
by losing a large part o£ its food through the nostrils, and thus 
undergoes partial starvation. At the same time, the lodgement 
of food in the nostrils irritates the parts, and its discharge there- 
from presents so repulsive an appearance that the animal is ren- 
dered valueless. 

The handling of Ossure of the palate, in domestic animals, is 
virtually barred by the great depth of the oral cavity, which 
prevents the surgeon from attempting to bring about an adhesion 
of the two sides by means of an operation, though in some cases 
it might be theoretically possible. 

8. Persistent Foramen Ovale. Cyanosis. 

In describing the fetal circulation on page 328, it was mentioned 
that, since the lungs are inactive up to the time of birth, their office 
must be performed by the placenta. In order that the blood 
leaving the right ventricle may readily pass to the placenta of 
the mother, there exists in the fetal heart a communication, 
the foramen ovale, between the two auricles. This should 
normally close at about the period of birth, but sometimes does 
not, and as a result the new-born animal suffers from cyanosis 
or a mixed circulation, in which the arterial blood assumes a 
venous character and gives to the visible parts a blue color. This 
defect is very rare, in animals When present it is usually accom- 
panied at the time of birth by extreme weakness, with rapid 
respiration and a deep blue color of the visible mucous mem- 
branes, the consequence of the partial asphyxia from which the 
animal is suffering. 

The condition is beyond remedy. Spontaneous recovery may 
occur. If the defect persists the animal may survive for some 
time. Zundel records a case in a horse which reached the age 



To7igiie-Tie. Hernia of the Brain. Odontonies 1069 

of 7 years. In man even a greater age is sometimes attained, 
though as a general rule the patient succumbs at a comparatively 
early date, except recovery ensues. 

9. ToNGUE-TlE. 

Veterinarians have recorded a few instances of tongue-tie, or 
decreased mobility of the tongue, due to a too restricted yr^wz^w 
Unguis. According to Tyvaert, who has observed a number 
of calves so affected, the defect prevents the prehension and swal- 
lowing of food. The animal cannot well drink milk from a pail, 
or readily grasp the teat to suck, and consequently tends to die 
of starvation. 

Examination of the tongue reveals the nature of the anamoly. 
The handling of it is very simple, and consists merely in dividing 
the frjenum linguse to a sufficient degree to permit of free move- 
ments of the tongue. 

10. Hernia Cerebri. Hernia of the Brain. 

Serious defects in the development of the brain usually lead to 
the death of the fetus immediately upon birth. We have made 
some interesting observations, where hernia of the cerebrum be- 
came hereditary in a family of swine bred upon one farm. The 
female line had been maintained unbroken for generations, while 
the boar used for breeding purposes had been regularly changed, 
and new blood introduced. Year after year, however, there oc- 
curred, with ever increasing frequency, new-born pigs showing a 
tumor in the frontal region, which was sometimes covered over 
with skin, and at other times showed a naked epithelial covering. 
In some litters of pigs the defect was apparent in more than 50%. 
Some of the pigs died after a few days, under symptoms of 
epilepsy, while others slowly recovered and the tumor disap- 
peared. The appearance of the hernia is shown in Fig. 32, 
on page 294. The defective family of swine was finally sold to 
the butcher, in order to avoid the recurring losses from the 
difficulty. 

II. Odontomes. 

In tracing the development of the teeth, on page 311, we sug- 
gested that during the embryonic period the dental follicles 



loyo Veterinary Obstetrics 

sometimes undergo aberrations which lead to more or less seri- 
ous consequences, not only for the integrity of the teeth, but 
also for the usefulness or the life of the animal. Some of these 
aberrations take place early in fetal life, and at the time of birth 
have acquired such proportions as to imperil the life of the ani- 
mal. This is especially true of the follicular cysts, of the com- 
pound follicular odontomes, and of the composite odontomes of 
the superior grinders. In these forms of aberrations in the de- 
velopment of the teeth, large cysts filled with lymph press their 
way into the sinuses of the face or into the nostril, and, by their 
great size, cause much deformity of the face, and such pressure 
upon the nasal passages as to threaten the death of the young 
animal by asphyxiation. 

When odontomes, especially large ones of the cj'Stic variety, 
are present at the time of birth, the foal at once shows difiiculty 
in respiration, because of the pressure upon the nasal chamber. 
There is bulging of the face over the area of the cyst, unilateral 
breathing, and a marked increase in resonance over the area of 
the cyst. 

The prognosis of odontomes is usually highly favorable under 
proper surgical handling, and equally unfavorable if neglected. 

The surgery of odontomes is usually demanded for the colt or for 
the adult, and only very rarely for the new-born foal. We have 
observed and recorded odontomes which have threatened the life 
of the foal before reaching the age of 90 days, and other writers 
have observed them at the time of birth. Since we usually do not 
obtain clinical evidence of their presence until after the colt has 
attained some age, it is not desirable to deal extensively here 
with their handling. Instead we merely draw attention to the 
occurrence of these in the new-born or very young foal, and refer 
the reader to the more extensive literature upon the subject in 
special surgery. 

12. Rupture of the Extensor Pedis Tendons in the 
Anterior Limbs of the New-Born. 

We have had occasion to observe, in the vicinity of Ithaca, 
N. Y., six cases of rupture of the extensor pedis tendons, of new- 
born foals, in the region of the carpus. How common the disease 
may be, we cannot say, since there are few records of its occur- 



Rupture of Extensa}- Pedis Tendons 



1071 



rence. Four of the cases observed by us occurred upon one farm, 
in two successive years, and comprised all the foals dropped upon 
the farm during that period. The foals were in some instances 
apparently well at the time of birth. Attempting to stand, they 
soon went over on their knees, and were quite unable to ex- 
tend the metacarpus upon the radius. Others showed more 
vigor, and for a time were able to get up and stand without aid. 
However, there was a constant tendency for the carpus to sud- 
denly flex forward and the animal to fall, though the more vigor- 
ous ones were able, with some difficulty, to stand, and to walk 
without falling. 

In all instances which we have observed, the tendons have 
ruptured in both legs, and the point of rupture is usually at the 
upper part of the carpal sheath, where the tendon merges with 
the muscle, as shown in Fig. 152. After the rupture, the end of 
the tendon drops down in its carpal sheath, and reunion with its 
muscle, either spontaneously or by surgical interference, becomes 
impossible. 

In one instance the rupture of the tendons was accompanied 
by extreme luxation of both patellae, the two patellae being com- 
pletely dislocated laterally, disabling the foal behind as well as 
in front, so that, when it was raised upon its feet and the ante- 




FiG. 152. Rupture of the Extensor Pedis Longus Mosci^e 
IN New-born Foal. 
Right anterior limb seen from in front. 
EM, Extensor metacarpus. i, Proximal ruptured end 

EP, Extensor pedis longus 2, Distal portion of tendon dropped 

EPA, Extensor pedis longus acces- down in the sheath, 3. 

sorius. 



1072 



Veterinary Obstetrics 



rior limbs extended, it assumed the position shown in Fig. 153. 
Of the six cases observed, four died in a few days after birth or 
were destroyed as hopeless. Two recovered, and are still living 
and performing satisfactory services, without extensor pedis 
muscles. The animals extend their fore feet by the extensor 
pedis accessorius and the extensors of the metacarpus, producing 
a peculiar gait. 

The cause of rupture of the extensor pedis tendons in the new- 
born is unknown. In the region where we have observed these 
cases, that group of bone diseases of which spavin, ring bone and 
navicular disease are typical, is very common, and it is possible 





HH^HH^'^ 


^ 


M 


^^^M^ 


■■£ ''''^B^^^H 


^^B 




^^^^HIIIS|Kl«E|HpilHH 


Upp 







Fig. 153. Extreme I^rxATioN of the 1'.\tei.L-5 in a New-born Foal. 

Accompanied by rupture of the two extensor pedis longus muscles of the 
anterior limbs. From a photograph. a. Patella ; b, Femoro-tibial ar- 
ticulation. 



Rupture of Extensor Pedis Tendons 1073 

that a relationship exists between these and the rupture of the 
tendons. 

The prognosis is exceedingly unfavorable, since, although 
some of the cases may live, their locomotion is interfered with 
by the absence of the extensor pedis lougus muscles, and the 
value of the animals is consequently greatly lessened except for 
slow work, because for driving or riding they would inevitably 
prove insecure upon their feet. For any fashionable use. their 
peculiarity of action would render them unsuitable. 

The handling of the malady is uncertain, and apparently there 
is little to do beyond taking good care of the animal and aiding 
it in getting upon its feet in order to suck. While the foal is 
sucking, an assistant should grasp it by the knees, and, pushing 
backward, prevent their flexion, thereby assisting the animal in 
standing. Unless the foal is of considerable value, it is advisable 
in most instances to destroy it at once. 



APPENDIX. I. 

THE GRANULAR VENEREAL DISEASE OF COWS. 

INFECTIOU.S Granular Vaginitis. Vaginitis Verrucosa. 
Infectious Vaginal Catarrh. 

On page 97, we have given a brief account of the granular 
venereal disease of cattle, basing our description upon European 
veterinary literature. We were not aware, at that time, of the 
existence of the disease in America. We there suggested that 
the disease might well be imported at any time, and that it might 
even then exist in America without its presence having been rec- 
ognized or announced. 

A few weeks later a communication reached us which led us 
to suspect the existence of the disease in a dairy herd in north- 
eastern New York. 

A visit of inspection to the herd confirmed our suspicions. It 
was then attempted to procure data regarding the probable dis- 
semination of the malady. The herd in which we recognized 
the malady was one in which no effort was made to raise dairy 
cows. Fresh cows were bought, milked and bred, their calves 
used for veal, and the cows butchered or sold whenever unprofit- 
able for dairy purposes. As a consequence, new cows were fre- 
quently entering the herd. Some of the new cows, which had 
been in the stable but a few days, were badly affected, which in- 
dicated that they had been diseased when purchased, and conse- 
quently that neighboring herds were similarly diseased. Soon 
afterward several herds in the immediate vicinity were inspected 
by other veterinarians, and reported similiarly affected. 

The results of these inspections led us to suspect that the 
malady had a somewhat extensive distribution. One large herd 
in southeastern New York had been reported to us as suffering 
persistently from abortion, and we were led to suspect that the 
granular venereal disease was present, and inspection confirmed 
our belief. We soon had opportunity to observe the affection 
in western New York, and especially in our immediate vicinity. 
In the region of Ithaca we have inspected a number of dairy herds, 
finding them uniformly infected. We do not know of a sound 
herd in our region. 
1075 



1076 Veterinary Obstetrics 

Veterinarians in various portions of the state, having had their 
attention drawn to the existence of the malady, find, upon search, 
that the disease is common in many locahties in New York. 

We have observed the malady in pedigreed breeding herds of 
Holsteins, Jerseys and Guernseys. Breeding stock is constantly 
being sold from these herds to all portions of the state and country. 
We have satisfactorily determined that affected animals have gone 
from New York to several other states, and that diseased cattle 
have been brought into New York from other states. 

How long the disease has existed in New York or in the United 
States, can not be determined. One veterinarian in Pennsyl- 
vania relates orally that he observed the lesions in aborting cows 
in his state some five or six years ago, but apparently made no 
public announcement of the fact. Breeders state also that they 
have observed the granular lesions in their herds for some time 
past. 

If we are to estimate the duration of the disease in America by 
its probable relation to abortion, it has existed for a long time. 
A serious malady, known as contagious abortion, has been wide- 
spread and has caused appalling losses to dairymen in New York 
and other states for more than a quarter of a century. How 
much of the abortion has been due to this malady, we do not 
know, and there is now no method for determining. At present 
we have been unable to find a dairy in which abortion exists, or 
has recently existed, where the granular venereal disease is not 
present in a severe form. 

Such observations as we have been able to make, in the few 
months elapsing since the recognition of the malady in this 
state, lead us to conclude that the disease has probably existed 
in the United States for a quarter of a century, that it is wide- 
ly disseminated wherever dairying is largely conducted, and that 
it is responsible for a very large part of the immense losses from 
abortion and sterility in cows. 

For these reasons, we consider it essential to add to the de- 
scription already given of this disease, some interesting data ac- 
quired through our investigations. Admittedly our observa- 
tions are incomplete, and any conclusions we may now draw are 
subject to revision. The investigations thus far made should 
suffice, however, to place veterinary practitioners on their guard. 



Granular Venereal Disease of Cows '^'^11 

lead them to make careful observations, and enable them to con- 
tribute important data to our knowledge of the malady. 

Our suspicions of the existence of the disease in this country 
were first aroused by a communication from a veterinary practi- 
tioner, relating to abortion and sterility in a dairy herd of 40 
cows, which we shall designate Herd i. The letter stated in 
part, "They have had considerable abortion the past year, and 
now many of their cows are sterile. Some have been bred as many 
as nine times without becoming pregnant." The sterilitj' was 
not confined to cows which had aborted, but included some 
which had recently given birth to apparently healthy calves. It 
was noted that the different bulls used in the herd seemed to suf- 
fer from enlargement of the penis, and became sornewhat indif- 
ferent sexually. The practitioner also stated that, following an 
interval of 1 2-24 hours after breeding, the cows bled somewhat 
from the vulva. Apparently this latter phenomenon was mis- 
interpreted, and really consisted of the regular menstrual flow 
following estrum without impregnation. In this disease, how- 
ever, the menstruation seems exaggerated. The general phe- 
nomena related are typical of the history of the prevalence of 
this malady in a dairy. 

Herd i. An inspection of the suspected herd, Jan. 3, 1909, 
revealed the fact that, of the 40 cows, 25, or 62.5%, showed 
typical lesions of the disease ; 4, or 10%, were regarded as ques- 
tionable ; and 11, or 27.5%, were apparently well. 

The symptoms were thoroughly typical. The lesions corre- 
sponded to those recorded by European investigators. Many 
of the moderately affected cases were identical in appearance 
with Fig. 154. The mucous membrane of the vulva was thickly 
studded over with countless granular elevations about the size of 
hemp seed. The areas of mucosa in which the granules were 
located were generally injected, sometimes intensely inflamed 
and thickened. In such cases, the granules were very abundant, 
reddish in color, but not so intensely injected generally as the 
contiguous mucosa. 

In many cases, where abundant granules of large size were 
present, the mucosa was not greatly injected. In these instances 
the granules were very prominent, not so numerous, but ap- 
peared larger. These were not usually injected, but were more 



1078 



Veterinary Obstetrics 



or less transparent, appearing like small, deep-seated vesicles, 
as if filled with a transparent, colorless lymph. 




Fig. 154. Infectious Granui<ar Vaginitis. 

Mucosa of the vestibule after three months duration of the dis- 
ease. (Hutyra and Marek, after Ostertag. ) 



Gramdar Venereal Disease of Cows 1079 

Vulvar discharge was generally present, and the muco-purulent 
substance accumulated in dirty crusts about the vulva and tail. 
The herd of 40 cows was established in 1905, and during the 
three subsequent years 74 different cows entered the stable, 34, 
or 46%, of which have been sold or slaughtered. Though the 
records of the dairy are not explicit as to reasons for disposal, 
the prevailing reason for slaughter or sale, so far as can be deter- 
mined, was abortion, followed by sterility and an unprofitable 
milk production. 

At the date of inspection, 24 cows, or 60%, were pregnant, 
and 16, or 40%, were barren. Many of these had been repeat- 
edly bred, without result, and several of them had proven so 
persistently sterile that it was intended to slaughter them for 
beef. The institution to which the dairy belongs requires a large 
amount of beef for its inmates, and consequently they have aimed 
to butcher each cow which proves unprofitable as a dairy animal, 
as soon as she can be put in fair beef condition. New cows in 
advanced pregnancy, or recently fresh, are bought to replace 
them, and thus the proportion of sterile animals is reduced to a 
minimum. 

. The data regarding abortion in the herd is also inaccurate. In 
general terms, the superintendent states that abortion has been 
frequent during the entire history of the dairy. Some have 
aborted two and three times in succession. Generally they are 
butchered before abortion occurs more frequently than twice. 

While the losses in this herd have not been so great as those 
recorded by some European observers, they have nevertheless 
been serious, so much so that the governors of the institution to 
which the dairy belongs are very anxious to check the severe 
economic losses. Since they do not attempt to raise the calves, 
they do not feel severely the direct loss from abortion or sterility ; 
and the fact that the institution can make good use of each fat 
cow for beef diminishes greatly the economic losses on the cows 
themselves. Even under these exceptional conditions, and with 
the disease in the herd of a mild character as compared with the 
malady in some other herds coming within our observation, the 
economic losses from impairment of milk production are proving 
a severe burden. It is difiicult, under the conditions, to produce 
sufficient milk, or at a reasonable cost, for the use of the inmates- 
of the institution. 



io8o Veterinary Obstetrics 

Herd 2. The next herd investigated by us consisted exclu- 
sively of pedigreed Jerseys. There were on hand, at the date of 
our first inspection, 228 cows, heifers and heifer calves. In addi- 
tion, there were 8 bulls of breeding age and 10 bull calves. 

In three stables containing 96 females, among which were a 
few cows, but mostly heifers from i^ to 3 years old, 89.6% were 
diseased and 10.4% apparently well. 

In a fourth stable, containing 40 cows and heifers, all in milk, 
98% were affected and 2% (i cow) apparently well. 

A fifth stable, designed for pregnant cows about to calve and 
for calves, contained 6 cows or heifers in advanced pregnancy or 
recently calved, 5 of which were evidently diseased and i appar- 
ently well. The remainder of the stock in this barn consisted of 
virgin heifers, and heifer and bull calves. 

Of 8 heifers about 9 mos. old, 8 were affected, o apparently well. 
" 20 " " 6 " '■ 18 " " 2 " " 

" 6 " "3 " " I " " 5 

" 7 " "I " " o " " 7 

" 3 " " I week " o " " 3 " " 

Of the total 44 virgin heifers and heifer calves in this stable, 
61% were diseased and 39% were apparently well. Excluding 
the heifer calves under 6 months, 93% of the virgin heifers were 
affected. 

In a sixth stable, containing 42 cows, chiefly adult or aged, 31, 
or 74%, were affected, and 11 ; or 26%, were apparently well. 

In the entire herd of 22 8females, 198, or 82.5%, were affected ; 
and 40, or 17.5%, were apparently well. If we deduct from the 
228 females, the 17 apparently well heifers and heifer calves not 
over 6 months old, and which we may assume remain apparently 
well because not yet infected, there remain 211 females, of which 
188, or 89.1%, are affected. 

The foregoing statistics, it has since been determined, are de- 
fective, and show too large a percentage of well animals. Cows 
in advanced pregnancy, or about to abort, when the vulva be- 
comes swollen and edematous, cease to show the granules in the 
vulvar mucosa, and con.sequently the number of apparently well 
is probably excessive to the extent of all of those cows which 
were very near to parturition or abortion, in which the lesions 
were hidden by the edema present. 



Granular Venereal Disease of Cows io8r 

The symptoms in this herd were far more intense than those 
observed in Herd i. In the cows and heifers which had calved 
or aborted, and in some of the virgin heifers, there was present 
a very noticeable muco-purulent vulvar discharge, which soiled 
the external portions of the vulva and the contiguous portion of 
the tail. The discharge adhered especially to the tuft of hairs 
at the inferior commissure of the vulva. Sometimes the muco- 
purulent discharge dried upon the vulvar tuft as dirty brownish 
crusts ; at other times the moist, sticky discharge hung down 
in ropy masses several inches long. Similar masses of discharge 
were observed upon the ventral and lateral surfaces of the tail. 

Upon separating the vulvar lips, there was observed, in many 
cases, adherent masses of muco-purulent secretions. Frequently, 
when parting the vulvar lips, the muco-purulent masses stretched 
across from side to side as adherent, tenacious strings, not losing 
their continuity until the walls of the vulva had been parted for 
a distance of two, three, or more inches. The discharges were 
generally tenacious, stringy, white, or rarely faintly yellowish, 
and more or less opaque. In some instances, the discharge was 
flocculent, and, upon separating the vulvar lips, the mucosa was 
seen to be dotted over with pale yellow, repulsive-looking, flat 
masses, o. i to i cm. in diameter. In one diseased cow, when- 
ever the vulvar lips were separated and the clitoris pressed from 
beneath, approximately one to two cc of a thick white pus were 
discharged from the prepuce of the clitoris. In addition to the 
vulvar discharges mentioned, muco-purulent discharges emanated 
from the vagina and the uterus. More than 2% of the affected 
cows had pyometra following parturition or abortion, and showed 
the same character of discharge as pyometra from other causes. 

The granular lesions in the vulvar mucosa were very much 
more pronounced than in Herd i. In the milder cases, the 
granules were few in number, and grouped largely about the 
clitoris. They were arranged in irregular, indistinct rows, cor- 
responding to the ridges in the mucous membrane. According 
to the severity of the case, the granules spread forward toward 
the vagina and upward along the sides of the vulva, to finally 
converge and meet on the roof of the vulva. Fig. 154 repre- 
sents a comparatively mild case as related to the area involved 
and the profusion of granules. As the superficial area of the 



io82 Veterinary Obstetrics 

disease increases, the irritation of the mucosa and the abundance 
of granules tend to increase. 

The granules are best observed by refracted light. The vulvar 
lips are readily parted with the fingers, when the granules are 
easily observed upon some portion of the mucosa, usually best 
on the side opposite to the observer. Changes in position and 
the obliquity of the illumination aid in bringing the granules in- 
to clear vision. In fair daylight, with the vulva of the animal 
directly or obliquely facing an open door or a window, ample 
illumination of the vulva is afforded, when the lips are parted. 
In dark stables, on a dark day, or at night, the vulva may be 
conveniently and amply illuminated with the aid of a good 
stable lantern. A good reflecting lamp or lantern is even better, 
and affords an illumination equal to sun-light. The ordinary 
small electric hand lamp with a dry battery gives an ideal light 
at night or in dark stables. When the granules extend over 
the entire circumference of the vagina, they may be best ob- 
served by holding the vulvar lips well apart and looking along 
the vaginal roof, when the granules will stand out very boldly. 

The granules differ greatly in color. In the intensely in- 
flamed cases, the granules usually partake of the deep injection 
of the surrounding mucosa, but are somewhat lighter in color 
and show a tendency towards transparency. In cases where no 
great irritation is present, the granules stand out prominently, 
as more or less translucent, hemispherical elevations. They 
are especially prominent in virgin heifers. 

When parturition or abortion is near, and the vulva becomes 
edematous, the granules disappear from view. They apparently 
do not cease to exist, but the general edematous condition hides 
them and produces an even surface as seen in Plate II, Fig. 4. 
So far as we have investigated, we are unable to detect the 
disease clinically at this period. In two or three weeks after 
abortion or parturition, the granules again become visible. 

The degree of irritation in the vulvar mucosa is not directly 
dependent upon the numbers of granules present, though in gen- 
eral the greater the number of granules, the more intense the 
inflammation of the mucosa. In some cases, especially after re- 
peated irrigations with antiseptics, the vaginal mucosa is normal 
or even pale in color. In severe cases, the mucosa is intensely 



Gra7tular Vetiereal Disease of Cows 1083 

red and angry-looking, and bleeds easily. It is sensitive to the 
touch, and the patient resists palpation. Urination causes some 
irritation of the parts, expressed by uneasy stepping and whisk- 
ing of the tail. When the irritation is very intense, the vulva 
becomes visibly swollen, especiallj' the upper portions of the 
labise, opposite the superior commissure. The vulvar lips at this 
region become distinctly enlarged, tense and sensitive. 

It was observed, during our investigations in this herd, that 
copulation greatly increased the vulvar irritation. So marked 
was this coital irritation that we were enabled to largely antici- 
pate the breeding history of a cow by inspecting the vulva. If 
bred within a week or two, the vulvar irritation was very greatly 
accentuated. This is in harmony with observations upon most 
coital infectious, and has a distinct and important influence up- 
on the question of therapeutics. No method of handling can 
well succeed under the irritation of copulation. 

Estrum also caused a somewhat increased vulvar irritation, 
but not of the same grade as coition. It seemed, also, that in 
this herd menstruation following estrum was especially marked 
and abundant. 

An interesting phase of the disease in this herd was the large 
percentage of heifer calves affected. European writers mention 
the occasional transmission of the disease to heifers and calves, 
but lead one to assume that such occurrences are rare. In this 
herd, 61% of all virgin heifers, or 93% of all virgin heifers over 
6 months old, were affected. This fact is very important in 
relation to abortion, sterility and the transmission of the disease 
from herd to herd. 

The method of infection in these cases is not wholly clear. 
Our investigations developed the fact that the same grooming 
implements, metal currycombs and stiff fiber brushes, were used 
alike on diseased cows in adjoining stalls, and on the heifer calves. 
In grooming, the vulvar region necessarily received extra atten- 
tion in order to rid the region of dried fecal, and other accumu- 
lations. In doing this, the vulvar lips were parted and the in- 
fected currycomb and harsh brush were brought into contact 
with the vulvar mucosa. 

Later observations, upon other herds, disclose the fact that 
such infection of virgin heifers is not common when they are 



1084 Veterinary Obstetrics 

kept iu stables with diseased cows, if the heifers are not 
groomed. 

The relation of the disease to abortion in this herd was appar- 
ently very important. Iu Herd i abortion was persistent but 
scattering. While no large number of abortions occurred in any 
month or year during the existence of the herd, the total for the 
three years was of distinct economic importance. 

In Herd 2, abortion was far more frequent and serious. It 
might be said that abortion was comparatively as much more 
frequent in this herd than in the first one, as the vulvar lesions 
were more abundant and intense. That is, the number of the 
abortions in the two herds was approximately parallel to the 
respective intensity of the lesions in the two herds. 

In this herd, 156 cows were bred to calve during 1908, and 
kept on the farm until the result was known. Of these, 42, or 
27 % , aborted ; and 1 4, or 9 % , were slaughtered because of sterility. 
Four cows or heifers, which had been bred and conceived, were 
sent to the butcher as sterile, after having aborted. Exact sta- 
tistics for prior years are not available, but abortion and sterility 
have been causing serious losses for a number of years. The 
■ ravages of abortion reached the climax in 1908. As accurately 
as statistics can be readily compiled, the losses in the herd, be- 
tween January 1901 and May 1905, averaged 0.5 abortions per 
month; between May 1905 and March 1907, 0.86 abortions 
per month ; and during 1908, 3.5 per month. 

Most of the animals aborting in 1908, and indeed throughout 
the history of the herd, have been young cows and heifers. 
Very largely they have been heifers pregnant for the first time. 
This is in harmony with our observations in other affected herds. 
Abortions occur chiefly in heifers, or in cows newly introduced 
into the herd. 

In this herd, one stable is made up almost wholly of adult 
cows, 42 animals in all. Of these, 31, or 74%, were affected, 
as against an average of 82.5% for the entire herd, though, in 
arriving at this percentage for the herd, new-born heifer calves 
were included. In this stable, where the largest percentage of 
apparently well cows was found, abortion was virtually absent, 
there being records of but two cases during a period of several 
years. 



Granular Ve^iereal Disease of Cows 1085 

We have stated above that the comparative frequency of abor- 
tion in affected herds is in harmony with the percentage of ani- 
mals affected and the average virulence as revealed by the vulvar 
lesions. This harmony is quite as well einphasized between the 
various stables in this herd. The abortions have occurred in 
those stables where the disease is most universal and the vulvar 
lesions most intense. In the stable of 40 cows, with 98% affected, 
the abortion was decidedly the most severe in the herd. 

The observations relative to the variations in the prevalence of 
abortion, in the different stables on this farm, bring up other in- 
teresting questions. Of the 17.5% of apparently well females, 
1 7 animals or 42. 5 % of those not showing vulvar lesions were virgin 
heifers, so young that it is a fair assumption that they were free 
essentially because they had thus far failed to become infected. 
Of the remaining 23 apparently well females, 1 1, or 27.5%, were 
adult cows in barn six ; and 8 others, or 20%, mostly adult and 
aged cows, were in another barn. Thus, in a herd consisting 
for the most part of young cows and heifers, there were 40 ap- 
parently well females, 42.5% of which were virgin heifers or heifer 
calves, 47.5% adult or aged cows, and but 10% among the 
young cows and heifers, which constitute the majority of the 
herd. 

Two assumptions seem to be warranted by the observations in 
this herd : 

1. As the cows grow old, and have been infected for several 
years, they acquire an indefinite immunity from the effects of the 
malady. The lesions become less intense, and abortion occurs 
less frequently or is wholly absent. 

2. The cow may eventually recover spontaneously, and the 
lesions disappear. This is in accord with the popular belief 
relative to ' ' contagious abortion ' ' , whatever that term may mean. 
It is commonly said that a cow aborts twice, and becomes im- 
mune. While in this herd there are sufficient cases to disprove 
this as a universal fact, there is much to support the rule. Sev- 
eral important questions which repeatedly arise in reference to 
spontaneous recovery may be tentatively answered by the observa- 
tions in this herd. It is one thing for a cow to recover from the 
disease and cease to be capable of transmitting it to other ani- 
mals, and quite a different matter for her to cease to abort. 



io86 Veterinary Obstetrics 

Many cows have the disease more or less intensely, yet breed 
regularly, and produce healthy, vigorous calves. The cows in- 
cluded in the 4.0 apparently healthy animals, in this herd, breed regu- 
larly, and drop healthy calves. 

Based upon this feature of the malady, a thriving trade is 
carried on by fraudulent veterinarians with "abortion cures". 
When a dairyman has lost one or two crops of calves, and turns 
with a forlorn hope to the " abortion cure " fraud and applies 
the remedy, if the time is opportune, the abortion ceases and the 
dairyman writes a "testimonial", but the disease remains in 
the herd, and sooner or later will again bring disaster. Should 
the fraudulent remedies be applied at an inopportune epoch, the 
abortion goes on, and the remedy seems almost to cultivate it. 
Thus in this herd the writer was informed that one of the most 
highly lauded " abortion cures " in America was given a com- 
plete trial in one of the stables, with the result that a far higher 
percentage of the cows aborted in that than in either other stable 
on the farm. The remedy was just as eifective as it ever is, but 
was used at the wrong time, when the abortion was not ready to 
cease. 

Another important element in connection with the outbreak in 
this herd is the prevalence of sterility. In dealing with the 
problem of sterility, and quoting Professor Hess, on page 171, it 
is asserted that the granular venereal disease is one of the most 
common causes of sterility from cystic degeneration of the 
ovaries. That is, according to the observations of Hess, that 
malady causes the ovarian disease. Our studies upon the herd 
in question went far to substantiate the views of Professor Hess, 
differing from his observations in some important respects, 
though in no wise contradictory. 

The herd records showed the most serious sterility, not in 
cows, but in heifers which had not bred at all, or, if they con- 
ceived, had suffered from invisible abortion, i. e., had aborted 
ere the fetus had reached a size that its expulsion was detected 
by the keepers. Fourteen such heifers were sent to the butcher 
during 1908 because all efforts at breeding proved futile. Some 
were served five to ten times each, without avail, estrum recur- 
ring regularly every three weeks. Others would show estrum 
regularly two or three times, then miss one, two or more periods 



Granida7' Venereal Disease of Cows 1087 

(pregnant?) and unexpectedly again show estrum (invisible 
abortion?). Finally, in despair, they were sent to the butcher, 
and the highly pedigreed animals of otherwise great promise be- 
came a total loss. 

The majority of the heifers became pregnant, and carried the 
fetus to the sixth, seventh, or eighth month, when they aborted, 
or gave birth to a premature calf, which with careful handling 
sometimes survived. After aborting, various troubles arose. 
Many suffered from retained placenta. A few died from septic 
metritis following the retained placenta. Some suffered severely 
from chronic metritis or pyometra. Many of the aborted heifers 
proved difficult or impossible of impregnation. 

Cystic degeneration of the ovaries and persistent hypertrophied 
corporealutea abound in the herd. In one stable of 38 females, 
manual examination of the internal genital organs was made, ex- 
cept in pregnant animals. Of those examined, five had cystic 
ovaries ; four had persistent, hypertrophied yellow bodies ; and 
two had pyometra. One of the cows affected with pyometra also 
had a cystic ovary, making five animals with cystic degeneration. 
Thus, amongst 38 animals, 11 or 29% had disease of the ovaries 
or uterus which would probably bar fecundation until properly 
handled. 

In a second stable of 40 cows, preparatory to handling, man- 
ual exploration was made per rectum, revealing cystic ovaries in 
1 1 cases and persistent yellow bodies in 9 animals, or abnormal 
ovaries in 50% of the cows. Some of these were not sufficiently 
affected to clearly interfere with breeding ; others were badly de- 
generated, and sterility very probable. Numerous cows re- 
mained sterile after several breedings. One was nymphomaniac. 
One heifer had aborted some months ago, and has not been ob- 
served in estrum since. The right ovary contained a yellow 
body I j4 inches in diameter, which was pressed out. Three weeks 
later, a new yellow body of nearly the same size was again pres- 
ent, in the same location as before, and it too was pressed out. 

The investigations in this herd thus indicate the correctness of 
the views of Professor Hess, that ovarian and uterine diseases 
very largely follow virulent attacks of the granular venereal dis- 
ease. 

Observations in this herd carry us even further in one impor- 
tant respect. The investigations indicate that in highly bred 



io88 Veterinary Obstetrics 

and unusually highly kept cows and heifers, are exposed to 
special dangers from the malady. Through grooming, with- 
out proper precautions being taken, the disease is trans- 
ferred to heifers and heifer calves, and the infection is al- 
ready in the genital tract before the animal is bred. 
Consequently, when the heifer is bred, the disease already ex- 
ists, rendering fecundation difficult or impossible. Should the 
heifer become impregnated, the chronic infection of the genital 
tract, already present for months, imperils the life of the fetus 
and may induce either abortion or premature birth, to be followed 
by various complications. 

Another interesting question has been raised by the clinical 
history of this herd. Mammitis of a very peculiar type sometimes 
occurs in heifers which are threatening to abort. In such, a 
severe, purulent mammitis now and then arises, causing atresia 
of the milk cistern or larger milk canals, so that when the heifer 
finally calves or aborts, one, two or more of the quarters are 
blocked, and no milk can be withdrawn. 

At the time named there is an excessive vulvar discharge 
which soils the perineum, tail, thighs and posterior portions of 
the udder. Thus it is suggested that the disease may indirectly 
cause some cases of mammitis. 

Herd 3. A third dairy inspected consisted of 87 cows, heifers 
and heifer calves. In one stable containing 30 cows in milk, 27, 
or 90%, were affected. In the same stable, in stalls compara- 
tively detached, were 24 heifers and heifer calves, of which 6 or 
25% were diseased, and )8 or 75 9^ apparently well. In two 
other barns were 33 females, mostly cows, with some heifers one 
year old or over, of which 31 or 94% were found affected. In 
the entire herd of 87 females, 64 animals, or 74%, were affected. 
There is at present no abortion in the herd. Four years since, 
approximately 50% of the pregnant cows aborted, and the fol- 
lowing year 25% aborted, since which time the herd has been 
free from abortion. During this period of freedom, few if any 
new Cows have been introduced. While abortion prevailed, the 
service bulls were subjected to disinfection of the penis and 
sheath before service. Granular venereal disease was not in 
miud, and not looked for by the veterinarian in charge. 
" Since the cessation of abortion, sterility has prevailed to a de- 
gree which has caused considerable economic loss. Three or 



Granular Venereal Disease of Cows 1089 

four cows have been sent to the butcher on this account. One 
was sent to the butcher because we had diagnosed ovarian 
abscesses. Our diagnosis was verified by post mortem examination. 
Aside from these, approximately 10% of the cows of breeding 
age have been handled annually by us for sterility due to ovarian 
disease. 

The lesions of the disease in this herd are more intense and 
more universal, in the cows of breeding age, than found in Herd 

1, and far less intense than in Herd 2. The prevalence of abor- 
tion and sterility in the herd is in harmony with the observations 
in the two prior herds. The lesions are not severe ; no new cows 
have entered the herd ; no abortions are occurring. The lesions 
are more intense than in Herd i, and sterility is present in a 
marked degree, and assumes definite economic importance. The 
sterility is due almost wholly to cystic ovarial degeneration, some 
cases to persistent hypertrophied yellow bodies, and one case to 
ovarial abscesses. 

The recorded observations by European investigators, coupled 
with the history of the abortion in this herd, followed by the 
large percentage of sterility and the high prevalence of the granu- 
lar venereal disease in the herd at present, warrant the assump- 
tion that the malady was present when the abortion raged. 

The small percentage of affected heifers and heifer calves in 
this herd is interesting, when compared with Herd 2. In Herd 

2, the heifers and heifer calves are kept in the same barn, and 
in close contact with a few badly diseased cows. The calves in 
that herd are regularly groomed, and the same currycomb and 
harsh fiber brush are used for grooming both cows and calves. 
The cows usually kept in the stable with the heifers are those in 
advanced pregnancy, and those which have recently calved or 
aborted. Many of them have abundant vulvar discharges, which 
greatly befoul the grooming implements and afford ample oppor- 
tunity for the carrying of the disease from cows to calves. 

In Herd 3, the conditions are different. The calves are kept in 
a distant part of the stable, virtually equivalent to a separate 
building. They are abundantly bedded and scantily groomed. 
They are not kept on exhibition for prospective buyers, as are 
those in Herd 2. 
69 



logo Veterinary Obstetrics 

Herd 4. This small herd consisted originally of grade cows, 
to which were added, by purchase, a few months prior to our ob- 
servations, 3 pedigreed Guernsey heifers and i pedigreed Guern- 
sey bull calf. We were asked to examine two of the three 
Guernsey heifers because of sterility. The three heifers and the 
bull, as well as the other cows and calves on the premises, were 
well kept, in good flesh and vigorous general health. In spite 
of repeated breeding, only one of the three heifers had become 
pregnant. 

Inspection showed all three Guernsey heifers affected with 
granular venereal disease (100%), while of the 6 original grade 
cows, 3 or 50% were affected. 2 heifer calves kept in another 
stable were healthy. In the herd of 9 females of breeding age, 
3 animals, or 33%, were sterile, one of the original stock having 
become sterile since the introduction of the Guernsey heifers. 
Abortion has not existed in the herd. Of the total of 1 1 females 
in this herd, 6 or 54% are affected. The history and condi- 
tions in this herd suggest that it was free from the malady until 
introduced by the purchase of the pedigreed heifers. 

Herd 5. A herd of 10 females, attended by my colleague. 
Dr. J. N. Frost, Instructor in Surgery, because of sterility in 2 
heifers. Of the 10 cows and heifers, 8, or 10%, were affected. 
The herd had suffered severely from abortion for several years. 
The two apparently well cows were adults. They have at no 
time suffered from abortion or sterility. The two sterile heifers, 
20% of the herd, were badly affected ; and each had cystic ovaries, 
which were crushed. 

Herd 6. A milk dairy consisting of 40 cows and 6 heifers. 
No herd records are kept, so that losses from abortion or sterility 
can only be estimated. In 1906, about 20% aborted ; in 1907 
about 15% ; and in 1908 about 10%. The degree of sterility 
could not be determined. The cows are mostly grades, and 
whenever sterility threatened, and the cow was at all fit for 
slaughter, she was sent to the butcher. Inspection showed 44, 
or 96%, affected ; and 2, or 4%, apparently well. The cows and 
heifers of breeding age were all affected. The sound animals 
were yearling heifers which had not been bred. The lesions were 
very moderate in intensity. One heifer had aborted in the sum- 
mer of 1908, was bred, and aborted in April, 1909. The abortion 
was followed by retained placenta. 



Granular Venereal Disease of Cows 1091 

Herd 7. A herd consisting of 12 cows and i yearling heifer. 
No definite record of abortions and failures to breed. Owner 
estimates loss by abortion in 1907 at 20%. In 1908, 10% of 
herd was sent to butcher because of sterility. The original herd, 
all common cows, have been sold recently, except 4 aged cows 
and the yearling heifer, and in their stead 8 pedigreed Holstein 
cows introduced. Of the four original cows, 2 are slightly af- 
fected, 2 apparently well. The yearling heifer is affected. The 
8 new cows are affected mildly to moderately, the lesions in these 
animals being apparently old. 

Examination of the genital organs of the 8 Holstein cows re- 
vealed I pregnant, 3 with enlarged persistent yellow bodies in 
ovaries, 2 with cystic degeneration of ovaries, i with enlarged 
uterus and cystic ovary, and i normal, non-pregnant. 

Herd 8. A herd of high-grade Jerseys, consisting of 53 
females. The herd has been kept unusually isolated. Few new 
cows have been added during the entire history of the herd ; 52 
of the 53 females were born on the farm ; and the one remain- 
ing cow was introduced into the herd some years since. 
New bulls, or rather bull calves, have been added from time to 
time. Eight or ten years ago a breeding bull was hired tempo- 
rarily from Herd 3. Owing to the continued comparative isola- 
tion of the herd and a history of virtual freedom from abortion 
for half a century, it was hoped to find a sound herd. An in- 
spection revealed 3 animals so near parturition that the presence 
or absence of the granular lesions of the vulva could not be de- 
termined. Of the other 50 females, 33 or 66% were affected, 
and 17 or 34% were apparently well. Among these 50 females, 
6 were heifers, 6 to 12 months old, which had not been bred. 
They were kept in the same stable, but fairly well isolated. They 
were carefully and plentifully bedded, but not groomed at all. Of 
these 6 heifers, i or 1673% was diseased, and 5 or 83)^% sound. 
This is in marked contrast with Herd 2, where the heifers were 
regularly groomed with infected utensils. 

The other 12 sound animals were mostly aged cows, which 
may have spontaneously recovered. 

On the whole, the percentage of affected animals is the lowest 
we have yet observed in a large herd. The lesions in the vulva 
are also less severe, the granules less numerous and less promi- 



1092 Veterinary Obstetrics 

nent, the irritation of the vulvar mucosa almost wanting, and 
vulvar discharge recognizable in but few animals. 

In harmony with these clinical data, abortion is rare, never 
exceeding, according to the owner's estimate, 2 to 4% in any 
year, while sterility is low. Probably an average of 4 to 5 % of 
the females are sent to the butcher annually for sterility, but 
dairymen in New York have come to regard this as possibly 
normal. Still, some abnormal losses from sterility are recognized 
by the owner of the herd. In 1908, 2 heifers were sent to the 
butcher because of sterility, a loss in these alone of 4% of the 
females of breeding age. These animals were of an age at which 
they should have bred promptly. 

The owner of the herd complains chiefly of the excessive 
occurrence of retained placenta, estimating the retention at 20%, 
although the cows are very well kept, strong and vigorous. We 
have casually inspected numerous other herds in the vicinity of 
Ithaca and elsewhere, uniformly finding them infected. Where 
the disease is severe, abortion is common ; where the malady is 
mild, the losses are correspondingly low. In no herd investi- 
gated do the results vary in any material way from those described 
in the 8 herds we have alreadj' reported in detail. 

The symptoms of the disease have been largely related above. 
Within 2-5 days after infection, the vulvar mucosa becomes in- 
jected, dark-red and swollen. The longitudinal rug« of the 
mucous membrane become more prominent, and within a few days 
small granular elevations about the size of mustard seed appear 
in the vulvar mucosa as hemispherical elevations above the sur- 
rounding epithelium. They appear mostly in somewhat indis- 
tinct longitudinal rows. Usually they are most prominent about, 
or just anterior to, the clitoris, and are seen chiefly along the 
summits of the longitudinal mucous ridges. In heifer calves, 
where the granules are usually few but very large and clear-cut, 
they sometimes tend to be confined to the immediate region of 
the clitoris. 

In moderate and severe cases, the granules spread completely 
around the vulva, but do not extend to the cutaneous margin. 
We have not observed the enlarged follicles nearer to the margins 
of the labise than ^^ inch. Forward, they extend as far as may be 
seen by parting the vulvar lips. The irritation of the mucosa 
increases anteriorly. 



Gra7iular Venereal Disease of Cows 1093 



INFECTIOUS VAGINAL CATARRH OF COWS. 

Photo- Micrographs after Thorns, from the Monatshefte fiir Praktische 
Tierheilkunde, Vol. 17. P 25. 



Fig. I. Section from the left side of the vestibule of the vagina showing 
an elevation in the mucosa due to a single follicle. 

Fig. 2. Section through 4 contiguous follicles which cause a single, 
rather flat elevation of the surface. 

PLATE II. 

Fig. 3. A Knob-like elevation of the mucosa due to several contiguous 
follicles. 

Fig. 4. A section from roof of the vagina, showing marked follicle-form- 
ation without macroscopically visible elevation of the mucosa. 



PLATE I. 





PLATE II. 




Fig. 3. 




1 096 Vetermary Obstetrics 

The injection of the mucosa varies in intensity in different 
herds, in diflferent individuals of the same herd, and in the same 
individual at different periods. The variations in intensity are 
frequently very abrupt, and sometimes not readily explained. 
When a non-pregnant animal comes in estrum, the mucosa be- 
comes increasingly irritated and reddened. If coition occurs, 
the irritation is very greatly increased. The entire visible portion 
of the mucosa is intensely inflamed, dark red, and swollen, and 
the epithelium is covered over with flocculent muco-purulent ex- 
udates. After estrum and service, the intensity slowly abates, 
and the mucosa may largely lose its irritated appearance in 10 
to 15 days. If pregnancy occurs, the vulvo-vaginal irritation 
may remain static, increase, or decrease. In old cows which 
have been long diseased, the mucosa becomes more pale, yellow- 
ish and flaccid. Ecchymoses in the mucosa are frequently 
observed. 

The vulvo-vaginal discharge is parallel to the degree of vagini- 
tis. Whenever the disease is intense, there is more or less con- 
stant mucous, muco-purulent or purulent discharge, which soils 
the tail and vulva, and especially adheres to the vulvar tuft of 
hairs. When complicated with pyometra, there is usually a pro- 
fuse purulent discharge, and one or two pints are frequently ob- 
served in the gutter behind the cow. 

The prepuce of the clitoris is occasionally the seat of profuse 
suppuration. In such cases, pressure from outside and beneath 
the clitoris, while the labise are parted, causes 15 or 20 drops of 
thick white pus to be pressed out. The lips of the vulva are 
frequently swollen, tense and somewhat sensitive to the touch. 

When parturition or abortion approaches, the enlarged follicles 
become less conspicuous, and finally disappear more or less com- 
pletely from vision. As soon as the vulva and vulvar mucosa 
become markedly edematous, when the animal is "springing", 
the granules rapidly become less conspicuous, and sometimes 2, 3 
or more weeks prior to parturition or abortion, the enlarged folli- 
cles are no longer visible. After the animal calves or aborts, the 
granules usually remain invisible for one or more weeks, until 
the edema of the external genitals subsides, when they reappear. 

The nodules have not ceased to exist, so far as we can deter- 
mine, but have merely become hidden in the edema of the mucosa. 
In some cases one may still recognize the hidden granules with 



Granular Ve^iereal Disease of Cows 1097 

the finger tips. In some cases the granules may remain hidden 
for even a longer period of time. In pyometra, following abor- 
tion or retained placenta, the vulvar mucosa may remain edema- 
tous and swollen for a long period of time, and the granules 
scarcely, if at all visible. According to our observations, the in- 
jection of the genital mucosa, just prior and subsequent to partu- 
rition or abortion, is more intense, and the tissues are darker 
and are usually more swollen than at the same period in 
healthy cows. 

The invisibility of the granules during the parturient state is 
significant and important. Failure to recognize the fact may lead 
to overlooking the disease, especially in cases of abortion and re- 
tained placenta, and cause the veterinarian to render a false diag- 
nosis. The error in diagnosis tempts the veterinarian to conclude 
that the malady has no important relation to abortion, because 
the co.ws which show the granules in abundance do not abort, 
and those which do abort show no granules immediately before 
or after abortion. If the disease exists in the herd, and the vet- 
erinarian is called to attend an animal for abortion or retained 
placenta, he should tentatively regard the patient as infected with 
granular venereal disea.se, and handle the case accordingly. Later, 
when the puerperal edema vanishes, the granules will generally 
become evident and verify the diagnosis. 

The symptoms in the bull are far less conspicuous than in the 
cow. This has led some veterinarians to conclude that the bull 
is immune to the disease and acts only as a passive bearer of the 
infection from cow to cow through coition. Others observe 
catarrhal inflammation of the genital mucosa, with muco-puru- 
lent dischage from the prepuce. The penis of the bull is not 
freely open to deliberate inspection. We have noted very marked 
muco-purulent discharges, which disappear under antiseptic irri- 
gations. The penis seems enlarged, and the mucosa injected and 
roughened. In some cases, ecchymoses about the preputial ring 
are very evident. In one herd, the herdsman complained that 
the bulls became lethargic and were slow to copulate. 

The diagnosis in the cow needs offer little or no difficulty. As 
in other diseases, so in this, an individual case may be question- 
able, but in a herd where it prevails, with the exception of preg- 
nant animals near to parturition or abortion, or during the puer- 



logS Veterinary Obstetrics 

peral state, the affected animals show definite and easily recogni- 
zable lesions. 

Pathology. The bacteriology has been extensively studied 
by Ostertag^ and other European investigators. Ostertag found 
a diplococcus or short streptococcus, which he grew in pure cult- 
ures, and injected into the vaginse of healthy heifers, inducing 
the symptoms of the disease. He recovered pure cultures of the 
organisms from the vulvar discharges of the diseased animals. 
The organism grows readily in glycerine agar, urine agar, and 
other neutral or alkaline media. It stains with most aniline 
bases, especially with methyline blue. 

The organisms are found in the muco-purulent discharges, be- 
tween the pus cells or within the protoplasm of these. They are 
able to penetrate the vaginal mucosa, and are found between the 
epithelial cells, as well as in the mucous pappillas, a fact which 
explains the great tenacity of the infection and the difficulty of 
curing it. 

While transmission experiments on healthy female cattle suc- 
ceeded, attempts to transmit the malady to horses, sheep, swine, 
goats, rabbits and Guinea-pigs were negative. Ostertag also at- 
tempted to transmit the disease to a bull, but failed to induce 
visible symptoms, and concludes that the bull does not become 
affected with the malady. This is in conflict with our observa- 
tions, since the breeding bulls in Herd 2 showed in some cases a 
distinct preputial catarrh. When the penis was exposed for copu- 
lation, it seemed swollen and deeply injected, and showed very 
marked ecchymotic areas at the preputial ring. We believed, 
also, that we saw granules similar to those in the vulvas of the 
cows, but the opportunit}' for deliberate inspection was not 
present. 

Ostertag found the organisms in the uterus of one cow, while 
in others he failed to find the cocci beyond the vagina, and con- 
cludes that it may persist in the vagina month after month", 
without invading the uterine cavity. 

For three months Ostertag handled one artificially infected 
heifer with alum and tannin (1-5% solution) and Lysol and Cre- 
oline(J^-i%) without results. Ostertag regards the disease, 
from his observation, as a very serious malady. Out of 250 ani- 



' Monatshefte fiir Praktische Thierlieilkunde, 1901, p. 536. 



Granular Venereal Disease of Cows 1099 

mals inspected by him, 120 had to be abandoned for breeding, 
because of vaginal discharge, sterility or repeated abortion. 

Ostertag recommends that the disease be handled by the official 
veterinarians, and quarantine be maintained against the intro- 
duction of diseased animals into healthy herds. His cultures 
from the closed uterine cavity were pure. The extension of the 
infection into the uterine cavity is significant. The fact prob- 
ably has a definite relation to the induction of abortion and 
sterility. Abortion, retained after birth and pyometra are per- 
haps referable directly or indirectlj' to the invasion of the uterine 
cavity by the organisms. Others have recognized the organisms 
in the degenerated ovaries. These facts or assumptions exert 
an influence upon the prognosis of the malady. 

The experiments of Ostertag and others indicate that the period 
of incubation is very short, 2-5 days, and that sometimes irrita- 
tation is evident within 24 hours. 

The granular elevations in the mucosa are due to swelling of 
the lymph follicles in the vulvar mucosa. They are most promi- 
nent in heifers. 

The complications and sequelae of granular venereal disease 
are diverse and important. 

Abortion. European authors are practicalh' unanimous in 
regarding it as the cause of much of the abortion in cows. Some 
regard the disease as identical with " contagious abortion", while 
most observers regard it as wholly distinct, nevertheless highly 
important as a cause of abortion. Many have observed 20, 50, 
70, and 80% of abortions for one, two or more successive years. 
In other affected herds, the disease exists for several years with- 
out the occurrence of abortion. In America we have no data 
available upon the question, beyond the observations related 
above. In numerous herds, where the disease exists in a mild 
form, no history of prior abortions can be obtained. We have 
no positive data how long the disease has existed in any one 
herd, but its wide dissemination, its presence in well nigh every 
herd in the regions inspected, indicate that it is not new. In our 
observations, 50% of abortions appears to represent the maxi- 
mum. It is not rare in the dairying districts of this state for 
80% to 90% or more of the pregnant cows to abort, but we have 
not, in the brief time elapsing since the recognition of the maladj% 
had opportunity to determine the presence or absence of the 



iioo Veterinary Obstetrics 

malady in such herds. Whenever the vulvar lesions are generally- 
intense in a herd, we have observed abortion in a serious degree, 
10-50%. When the vulvar lesions in the herd are as a rule mild, 
abortion is rather unimportant or absent. 

Premature births are also not rare. They occur in those herds 
where abortion is common. The calves are weak, though some 
of them survive. Prematurely born calves apparently suffer di- 
rectly from the infection in many cases, and repeatedly emit a 
peculiar bleat which dairymen recognize as belonging to conta- 
gious abortion. 

Retained placenta is common, following abortion, premature 
birth and calving at full term. The retention is comparatively 
severe and serious. It occurs in well kept, vigorous cows and 
heifers, as well as those which are emaciated or weak. 

Septic metritis, septicaemia, pyaemia, and pyometra fre- 
quently follow abortion, premature birth and full term parturi- 
tion. These complications are severe and malignant. They offer 
otherwise the usual symptoms, course and prognosis. 

Death of the fetus, without expulsion, but undergoing emphy- 
sematous decomposition instead, occasionally occurs. The fetus 
perishes ; the cervical canal dilates tardily and incompletely ; 
emphysema occurs promptly ; the uterus becomes paretic from 
distension or gangrene ; no visible, or only feeble, labor pains 
occur ; and the first symptom to attract the owner's attention is 
the protrusion from the vulva of decomposing afterbirth, or the 
appearance of a dirty reddish or brownish, thin, fetid discharge 
from the vulva. 

Diseases of the ovaries are among the most common and 
serious complications and sequelae. These have been alluded to 
in our account of the prevalence of the disease in various herds. 
When the disease is mild in a herd, ovarian diseases may be un- 
important or absent, but when severe, 10-50% of the animals 
may suffer from ovarian diseases, and become thereby sterile. 

Cystic degeneration of the ovaries is the most common 
form of resulting ovarian disease. We have already discussed 
this disease under " Sterilitj' " on page 161. 

Persistent, hypertrophied corpora lutea are also common 
following this disease. These too have been discussed while deal- 
ing with sterility. 



Grafiular Venereal Disease of Cows iioi 

Accompanying these ovarian diseases are frequently nympho- 
mania or absence of estrum (stillochsigkeit). One large, vigor- 
ous heifer in Herd 2 aborted at 2 years, and after an interval of 
6 months has not been in estrum so far as discovered. The left 
ovary contained a hypertrophied corpus luteum i ^ inches in 
diameter. It was crushed out. Three weeks later, another of 
similar size had formed in the same place. It too was pressed 
out. These diseases may possibly recover spontaneously. In 
mild cases of the disease, a large proportion of cows breed, if the 
cysts or yellow bodies are pre.ssed out. 

Abscess of the ovaries occasionally occurs. In one case, we 
diagnosed the condition by rectal palpation, supported our diag- 
nosis by digital exploration through an incision in the vagina as 
for spaying, and verified the conclusion by post mortem 
examination. 

Inflammation of the oviducts, pyosalpinx, is also observed. 
Presumably the diseases of the uterus, oviducts and ovaries are 
due to an extension of the infection along the genital tract, in- 
volving the oviducts, which may leave them permanently affected, 
containing pus (pyosalpinx) or causing atresia. When ovaritis 
or abscess of the ovaries occurs, the pavillion of the oviduct may 
become adherent to the gland. 

The significance of the disease to the cattle breeder is 
highly important. European investigators, in Switzerland, 
Austria, Italj-, Germany and Denmark, are practically unani- 
mous in regarding the disease as one of the worst scourges 
known to dairymen. Hutyra and Marek (Special Pathology 
and Therapy of Domestic Animals), Friedberger and Frohner 
(Special Pathology and Therapy), Ostertag, Hess, Zschokke, 
Nielsen, and other European investigators, teachers,. and authors 
of the highest rank, unite in regarding the malady as exceed- 
ingl}' serious from the standpoint of economics. Some observers 
regard it as more to be dreaded, economically, than Foot-and- 
Mouth Disease. 

The data submitted in regard to the various infected herds in- 
vestigated by us indicate that it is no less serious in America. 
The fact that some affected herds apparently suffer no ill conse- 
quences from the malady neither removes nor ameliorates the 
losses incurred in others. In one herd, where tuberculosis has ex- 
isted in a large measure and the Bang method is being applied , the 



II02 Veterinary Obstetrics 

manager is very emphatic in the view that the granular venereal 
disease is much the more expensive and dreadful of the two 
maladies, coexisting in the herd. 

The frequently appalling losses from abortion, and the sterility 
accompanying the malady, make it highly important that the 
dairyman and cattle breeder recognize this as a serious affection, 
and enlist the best veterinary advice for the purpose of prevent- 
ing and eradicating the disease. 

To the veterinarian, the recognition of the malady, and 
its importance, is of even greater consequence. "Conta- 
gious Abortion" and "Sterility" have long been a nightmare 
to the American veterinarian. He has been helpless to extend 
any scientific aid or advice to the dairyman or breeder, and has 
opened the way and left the field unoccupied and undisputed for 
the charlatan, with his nostrums for abortion, and his panaceas, 
impregnators and sorcery for sterility. 

If the veterinarians will but recognize and scientifically study 
this malady, much of the abortion and sterility may be brought 
under control, and a long-standing, unfortunate odium of inefiB- 
ciency in reference to these common diseases removed. 

The clinical proof of the seriousness of the malady, and its 
connection with abortion and sterility, is well supported by our 
observations, as well as by the testimony of the highest Euro- 
pean writers. The relation of the granular venereal disease to 
abortion and sterility is supported by the following data, already 
enumerated above : 

1. In each herd where abortion and sterility are causing, or 
have caused, serious losses, the granular venereal disease is very 
prevalent, and of medium or severe degree. 

2. The amount of loss from abortion and sterility is in harmony 
with the intensity of the visible lesions. If the general average 
of the lesions in the herd is intense, the losses are severe ; if the 
lesions are mild, abortion and sterility are rare or may be absent. 

3. In infected herds, when the animals are kept in separate 
groups in different stables, and the disease varies in intensity in 
the different stables, abortion and sterility show like variations. 

4. In affected herds, adult animals which show no lesions in 
the vulva, without exception breed regularly and do not abort. 

5. No other tangible explanation for the occurrence of the 
abortion, or of the ovarian, uterine or tubal disease leading to 
sterility, has yet been offered. 



Graiudar Venereal Disease of Cows 1103 

The prognosis of the disease, based upon European observa- 
tions and those thus far made in America, is very unfavorable 
unless vigorous prophylactic and curative measures are insti- 
tuted. Some believe in spontaneous recovery, and there is much 
to support this belief. In one stable in Herd 2, there is a number 
of aged cows, which are apparently sound, breed regularly and 
promptly, and give birth annually to healthy, vigorous calves. 
These animals stand side by side with diseased cows year after 
year, and are served by the same bull, and the diseased and 
healthy cows are groomed with the same utensils and handled 
by the same persons without precautions. These facts combine to 
indicate either that these cows have always possessed immunity 
or have at one time been diseased, have recovered, and acquired 
immunity against the malady. 

How long a time is required for such spontaneous recovery is 
purely speculative. In most of the herds observed, 50 to 80% of 
the aged cows are now affected, and the history of most of these 
herds indicates that they have been infected four or more years. 
If these assumptions are correct, the outlook for early spontane- 
ous recovery is certainly poor. A pregnant affected cow brought 
to the college has now been under observation five months, is not 
exposed to fresh infection, and is well kept ; but the lesions are 
now as pronounced as they were when first examined. 

Our observations indicate, however, that diseased animals, 
after a time, acquire a degree of immunity against the effects of 
the disease. A cow aborts one year, perhaps a second year, and 
possibly a third, and then proceeds to carry her calf full time, 
and it is born vigorous and healthy. In an aborting herd, the 
body of the herd largely ceases to abort. New cows introduced 
into the herd very largely abort. Heifers raised in the herd, 
and probably infected at the first breeding, abort the first calf ; 
and, if they remain fertile, probably abort the second calf; and, 
passing this ordeal, may breed regularly. 

The prevalence of sterility is apparently somewhat analogous. 
If the cow continues to breed for the first few years after she 
has become diseased, she will probably continue to breed per- 
manently. Sterility is very common and ruinous in herds where 
the disease is already present in the virgin heifers, and the basis 
for the sterility is laid prior to coition. Such sterility defeats 
the breeder and dairyman wholly. 



II04 Veterinary Obstetrics 

The acquired immunity to abortion affords the charlatan his 
opportunitj' to play upon the credulity of the owner and profit 
by the sale of his nostrums. If he sells his nostrums at the 
opportune moment, the owner believes a cure has been effected, 
when in fact there is an acquired immunity to abortion in the 
animal, though the actual disease is still there, ready to spread 
to other susceptible animals, or, upon provocation, to again flare 
up and cause abortion, sterility, or other disagreeable con- 
sequences. 

Intelligently handled, the prognosis is good. Such is the 
general view of European authors, and such are the indications 
based upon our observations. Our experience is too brief, how- 
ever, to warrant unqualified acceptance of any of the conclusions 
to which we may have come. The cure of the disease is no idle 
task. 

The germs, being deeply imbedded among the epithelial cells 
and in the follicles of the genital mucosa, can neither be readily 
washed away nor killed in position. Evidently the basis of 
treatment is disinfection, but the thorough destruction of disease- 
producing organisms so deeply entrenched is a difficult task. 
Yet the experience of others, and our brief efforts, indicate that it 
is by no means a hopeless task, but one which promises definite 
and satisfactory results, at a very small expenditure of labor and 
material, when compared with the benefits to accrue. 

The prophj'laxis is simple. The handling of sterility following 
the malady is quite satisfactory. 

The treatment of the disease is based fundamentally upon 
disinfection. Four important questions arise, none of which are 
fully decided. It has not been determined what disinfectant is 
best, in what degree of concentration the disinfectant shall be 
used, the extent of the area requiring disinfection, or the manner 
and frequency of application. Richter (B. T. W. No. 42, p. 774) 
advises bacillol ointment, and reports cures in 28.6% of cases in 
4-6 weeks. Diem, (W. f. T., Vol. 1,1, p. 181), prefers irriga- 
tions to ointments, and commends ^^-1% formalin. Wohlmutter 
(Thierartzliche Centralblatt, 1906, No. 2, p. 4) favors bacillol 
ointment in capsules, and considers two months the minimum 
time for healing. Raebiger (B. T. W., 1906, No. 13, p. 241) 
advises a 6-io% bacillol ointment as the best method, and applies 
this with a special syringe. This he would alternate with a 2-3%. 



Granular Venereal Disease of Coivs 1105 

iodine ointment. Poschel (B. T. W. 1906, p. 323) advises a 
mixture of lard and bacillol enclosed in gelatine capsules and in- 
serted with the fingers twice weekly into the vagina. Blau { Alla- 
torvosi Lapok, 1906, No. 2) recommends 3% creoline injections, 
with which he claims to induce a cure in 8-10 days (?). 

Ostertag (Monatshefte f. Prakt. Tierheilkunde, 1901, p. 532) 
would handle the malady with a 2 to 5 % solution of lactic acid 
or 2 to 5% solution of creolin. He warns against stronger 
solutions than 2.5%, because they irritate greatly and cause con- 
tinued straining. He excludes silver nitrate as a disinfectant 
on account of its cost. He warns veterinarians to use care in 
prescribing to laymen, and to get the measurements precise. 
Such irrigations of the vagina should occur 2 to 3 times daily. 

Ostertag, in harmony with the recommendations of R. Frohner, 
Martens and Ellinger, recommends the following measures for 
control and eradication : 

1. The isolation of the sound from the diseased, as far as 
possible. 

2. Disinfection of the stables, especially of the stanchions, 
floors, gutters and passage ways. 

3. Cleansing the vulva and neighboring parts from the accumu- 
lated vulvar discharges. 

4. Withdrawal of affected cows from breeding. 

The same rule should be applied to breeding bulls. If there 
are evidences of preputial discharges, the bull should not be used 
for breeding until apparently cured. 

In infected herds, the penis and sheath should be disinfected- 
Ostertag is of the opinion, also, that the disease should be 
officially recognized, and dealt with as contagious by the veteri- 
nary police service. 

Without noteworthy exception, all investigators report the 
malady very obstinate to handle, requiring vigorous and per- 
sistent treatment, but finally yielding. 

Our experience in handling has been confined to Herd 2. In 
this herd, a stable containing 38 cows and heifers was placed 
under treatment on March 6th, or the following days. 

Two coTTs were placed upon vaginal injections of o.^'/r carbolic acid on 
March 7. From March 7-15 inclusive, No. i apparently improved. On 
March 16, she strained severely, and the straining was continued after each 
irrigation, along with increased irritation and injection of the genital mu- 

70 



I io6 Veterinary Obstetrics 

cosa, and increased discharge, until the iSth, when treatment was omitted. 
On the 19th, I "/r solution of soda bicarbonate was injected, which caused 
no straining, but the irritation and increased vaginal discharge continued 
until April 4th, when she was placed upon daily vaginal irrigations with 
o. 75 fc bacillol. Since that date there has been gradual improvement, and 
no further change has been made. 

In No. 2 no irritation appeared until March 20th, and then only slight, 
but it persisted to some extent, and the irrigations were continued until 
April 4, when the improvement was slow and unsatisfactor}', and the treat- 
ment changed to 0.75% bacillol. 

A third cow was handled by inserting into the vagina, once daily, a gela- 
tine capsule containing two drams of powdered iodoform. This treatment 
was continued from March 7-1 7th, with constantly increasing irritation of 
the vulvar mucosa and increasing muco-purulent discharge. At this time a 
change was made too.5 9f carbolic acid, which caused much irritation, and 
another change to i Jip soda bicarbonate solution, which was continued until 
March 30th. A return was then made to 0.5% carbolic acid, which was 
continued with little improvement till April 4, when a change was made to 
0-75% bacillol, since which time progress has been satisfactory. 

A group of 7 cows, 5 on March 6 and 2 on March 7, were placed upon 
daily vaginal irrigations of o.75 5(i bacillol. Each cow improved markedly 
and satisfactorily from the first. The irrigation caused no straining, the 
vaginal discharge decreased, the injection of the vulvar mucosa receded until, 
on April 26, they had so far recovered that it was advised to breed them 
whenever in estrum. The granular elevations were still present, but very 
inconspicuous, flattened and pale. One of this group had been served by 4 
different bulls, in all 8 services, and aborted at 8 mouths on February 2, 1909. 
At beginning of handling, pyometra was present, and the uterus contained 
about I gallon of pus. The os uteri was firmly closed. The ovaries could 
not be grasped per rectum. The uterus was massaged per rectum from be- 
fore backwards April 4, the uterus was normal. The right ovary contained 
a yellow bod)' % inch in diameter, which was pressed out. The left ovary 
was normal. Between April 26 and May 23, the cows in this group had 
been bred. Inspection on May 23 showed irritation, apparently as a re- 
sult of copulation, in but one animal, the cow which had suffered from 
pyometra. 

On March 6, a group of 5 cows was handled b)- introducing deeply into 
the vagina of each a gelatine capsule containing 2 drams of powd. iodoform. 
This was continued daily until March 17th, or 10 days. The muco-purulent 
discharge, the irritation, and the prominence of the granules increased, but 
the patients did not strain. 

On March 17, each animal in the group received an application of oint- 
ment containing 55^ each of iodoform and tannin. This caused intense 
straining, and the experiment was discontinued. 

On March 18, the group was placed upon 0.75% bacillol, since which 
time the animals have slowly improved, but, after more than 5 weeks under 
bacillol, did not show such improvement as those which had been placed on 
bacillol from the first had shown after 3 or 4 weeks of handling. Appar- 



Granular Ve/iereal Disease of Cows 1107 

ently the iodoform treatment had proven harmful, and interfered with the 
progress after the cases had been placed on baciUol. 

A group of 4 virgin heifers received, March 6, one gelatine capsule each, 
containing 10% baciUol ointment, introduced deeply into the vagina. For 
a few days they appeared to bear the ointment well, and it was repeated 
daily. Gradually irritation appeared and increased, the discharge became 
more conspicuous, the vulva became swollen, straining began and loss of 
appetite occurred. On March 12, the irritation had become so marked that 
treatment had to be suspended. In place ofbacillol ointment, we used, for 
a da}' or two, a 0.1% permanganate of potash solution, and on the 17th 
changed to 5 % bacillol ointment. This could not be borne, and we again 
usedo.i^ potassium permanganate, under which the irritation abated, but 
no marked progress was made. On April 5, two of the heifers were removed, 
and the other 2 were changed to 0.75% bacillol. 

A 2}^ year heifer, after having been served 9 times and by 5 different 
bulls, presumably conceived, and later aborted. This conclusion was predi- 
cated upon suspension of estrum for 4 months, after which it returned. On 
March 6, 1909, she received an irrigation of 1 % carbolic acid, tannin and 
glycerine, which caused severe straining for i % hours. On March 7, the 
vulvar mucosa was much irritated. She received a 1-4000 corrosive subli- 
mate solution, which caused severe straining. The same was repeated on 
the 8th. March g she received a 2 % solution of lactic acid, which caused 
very intense straining. On March 10, she received an application of 10% 
carbolic acid ointment, which caused some straining. This was continued 
for 5 days. On March 15 and 16, she received 10% bacillol ointment, which 
caused slight straining. From March 17 to April 5, she received daily a 2% 
iodine ointment, with little straining or irritation. On April 6, she was 
placed upon o. 75^^ bacillol, since which time she has improved slowly. 

A group of 5 cows received, on March 6, vaginal injections of i % carbolic 
acid ; all strained violently for i}i hours. As all were in somewhat advanced 
pregnancy, it was deemed dangerous to continue so irritant an application. 

On March 7, each animal in the group received in the vagina a gelatme 
capsule containing 2 drams iodoform. This treatment was continued till 
March i5, accompanied by little or no straining, but the irritation and dis- 
charge did not improve. On March 17, a change was made to 5% carbolic 
acid ointment, which caused straining and irritation. 

On March iS, a change was made to irrigations with o.i'/r potassium 
permanganate solution, under which there was slight, but unsatisfactory 
improvement until April 6, when they were placed upon o. 75 '/r bacillol 
solution, from which date slow improvement has occurred. 

A group of 5 affected animals was placed upon daily vaginal irrigations 
of o. I '/c potassa permanganate on March 6. All seemed to do well and im- 
proved slowly for 3 or 4 weeks, when they began to show irritation and in- 
creased discharge, without any marked decrease in the number or size of 
the granules in the vulva. One, well advanced in pregnancy, showed 
signs of approaching parturition on April 7, and the vaginal irrigations 
were suspended on April 14th. Another, also pregnant, showed increased 
irritation, and on April 4 the potassium permanganate solution was reduced 



iio8 Veterinary Obstetrics 

to 1-2000, but the irritation continued, and the irrigation was stopped. 
A third animal behaved similarly to the two preceding ; treatment 
suspended because of approaching parturition. Calved March 22, re- 
turned to stable March 29 and treatment resumed. The animal was ill April 
I, apparently from overfeeding. On April 17 she was removed to another 
stable, and treatment suspended. The two remaining animals made little or 
no progress up to April 4, or one month, and the experiment was abandoned. 
The general result from potassium permanganate irrigations had proven un- 
satisfactory. At first it was deceptive, the animals apparently' improving 
and straining none, but later irritation became marked, more or less strain- 
ing appeared, and there was a decided increase in the muco- purulent vagi- 
nal discharge. At the end of the experiment the granules were as numerous 
and prominent as ever, Three of the group were placed upon bacillol at 
the close of the experiment, but after three weeks of handling were not 
nearly so much improved as new cases placed upon the bacillol at the same 
time. 

A group of 5 animals received, March 6, vaginal injections of 2'/i bacillol 
solution, which induced severe straining for one hour. A change was made 
on March 7, to 105^ bacillol ointment in capsules, which by March 17 was 
causing so much straining that it was abandoned, and for one day a 0.75% 
bacillol solution used. On March iSth a. ^'/r bacillol ointment was tried, 
but again caused irritation, and on the following day o. [ '/r potassium 
permanganate solution was substituted, and continued with indifferent and 
unsatisfactory results until April 19, when a change was made to 0.75% 
bacillol. 

Owing to many inquiries concerning the efficacy of various proprietary 
abortion nostrums, it was decided to test one of them alongside other reme- 
dies for comparison. For this purpose, one of the best known was selected, 
and a supply ordered. A group of 4 cows was placed upon this remedy, 
each animal receiving the treatment daily, according to directions, from 
March 17 to April 18, without any improvement in the symptoms If any 
change, they were worse than at the beginning. They were then placed 
upon 0.75% bacillol solution, since which their progress has been slow, but 
definite. 

On April 4, a group of 40 cows, all in milk, some pregnant, were placed 
upon daily vaginal irrigations with 0.75% bacillol solution, vulvar irriga- 
tions with 2^f bacillol and daily washing of the tail, perineum and buttocks, 
with 2'/( carbolic acid solution. Inspection 22 days later, on April 26, 
showed uniform and satisfactory improvement. 

Inspection of this group on May 23, or 49 days after commencement of 
the treatment, revealed a very satisfactory condition. All had greatly im- 
proved. Quite a number had been bred without causing any visible relapse. 
In 3 or 4 cows the breeding had apparentlj' retarded the progress toward 
recover}', though only slightly. In general the granules were decreased in 
number, flatter, less conspicuous, the vulvar mucosa slightly or not visibly 
irritated. Some animals, badly affected at the commencement of the 
handling, 7 weeks before, were to all visible appearances wholly recovered. 
Ever3thing indicated a complete recovery at an early date. 



Granular Venereal Disease of Cows 1109 

In all the foregoiug experiineuts, the cows received daily wash- 
ings of the tail, buttocks and perineal regions with 2% carbolic 
acid solution, except for a short interval when, in the absence of 
carbolic acid, lysol or bacillol was used instead. It was found, 
however, that 2% bacillol or lysol on the skin proved irritant, 
causing much switching of. the tail and stamping with the feet. 
It was consequently reduced, for external washing, to i %. 

In the foregoing work we limited ourselves, at the beginning, 
to the external washings and the introduction of the ointments, 
powders, solutions, etc., deeply into the vagina. The latter 
caused much irritation and straining whenever even moderately 
strong antiseptics were introduced. 

Above we have quoted European authors as using and recom- 
mending vaginal irrigations with 2-3% bacillol, creolin or lysol 
solutions, or other antiseptic solutions of similar strength. We 
were quite unable to use these, because of the straining and irri- 
tation. But we found that we could use concentrated antiseptic 
applications in the vulva without serious difficulty. 

European authors do not definiteh* record the amount of 
irritation induced by 2% vaginal injections. We do not under- 
stand how good results could be obtained under such violent irri- 
tation as we induced with concentrated solutions. In our expe- 
rience, the irritation retards recovery. After the use of irritant 
injections, we have found that not only has no progress toward 
recovery been made while they were used, but, after their aban- 
donment, the application of otherwise efficient remedies induces 
a much more tardy improvement than in cases which have not 
been touched. Possibly the quoted European authors do not 
differentiate between the vulva and vagina, and introduced the 
antiseptic solutions into the vulva only. If so, our experience 
thus far coincides, as we can use similarl}- concentrated solutions 
in the vulva. 

Hess, speaking of sterility, intimates that much harm is done 
by using too concentrated vaginal injections, inducing thickening 
of the vaginal walls, adhesions and other lesions which may cause 
insurmountable sterility. 

Based upon our limited experience, we advise daily 
vaginal irrigations of 0.75% bacillol solution, preceded by 
disinfection of the tail, perineum and buttocks with a 2^ 
carbolic acid solution and followed by a vulvar irrigation 



mo Veterinary Obstetrics 

with 2<fo bacillol or carbolic acid. The solution should 
have a temperature of approximately ioo° F. 

We advise that a suitable galvanized iron, or other pail, of 
about 5 gallons capacity, be procured, and fitted with a metal 
faucet. A lo foot pure gum horse stomach tube should be 
attached to the faucet. The stomach tube is by all means the 
best appliance known to us for conducting the fluid from the 
container to the desired part. When washing the external 
parts, the operator can shut off or control the rate of flow by 
placing a finger over the outlet of the tube. The tube is smooth 
and pliable, so that its introduction deeply within the vagina 
can work no injury, and yet has enough rigidity that it can be 
introduced through the vulva into the deepest part of the vagina 
without introducing the hand. 

A heavy wire is tightly stretched just behind the row of cows, 
and a puUy and hook placed upon it. The wire should be 
stretched by means of a heavy screw bolt, so that the track can 
be so tightly stretched that it will not materially sag in the 
middle when loaded with the five gallon pail. The pail contain- 
ing the solution for washing or for irrigating the vulva or vagina 
is then suspended from the pulley, the stopcock opened, and the 
work carried out. 

We believe it desirable as a rule, to introduce the remedy to 
the deepest part of the vagina, and not content ourselves with 
irrigating the vulva only. The findings of Ostertag and others, 
that the infection sometimes gains the uterine cavity, suggest 
that in some cases the irrigations must extent into that cavitj'. 
After the outside is well washed, the operator may open the vulva 
with a thumb and finger, and flush it with the same solution, 
but it is better, in our judgment, to disinfect the vulva after the 
vagina has been irrigated. The vaginal irrigation is to be per- 
formed bj' inserting the tube, by a somewhat rotary movement, 
through the vulva, deeply within the vagina, where it is gently 
maintained until the vagina is well filled. When the vagina be- 
comes thoroughly distended, the fluid obliterates the mucous 
folds and reaches every part. This sometimes requires 2 or 
more quarts of solution. Ordinarily about 5 gallons are required 
for washing the external parts or irrigating the vaginae of 15 
cows. The complete handling of 50 cows for one day can be 
accomplished by one man in about 2 hours. The cost per day 
for disinfectants by this plan is about 2.5 cents per cow. 



Granular Venereal Disease of Cows mi 

Bacillol appears to possess some very important advantages as 
a disinfectant in this disease. The saponaceous solution breaks 
up and washes away the vulvo-vaginal discharges apparently 
more completely than any other disinfectant we have tested. 
Permanganate of potash seems to precipitate the muco-purulent 
discharge and cause it to remain in place, and other disinfectants 
behave somewhat similarly. lyysol, cresol, and some other drugs 
of this group, may prove quite as efficient. One party reports good 
results with o.oi% corrosive sublimate. Ointments, highly 
recommended by European writers, have failed in our hands. 
Perhaps we have introduced them too deeply into the vagina, 
when they should have been placed in the vulva only. Ap- 
parentl}' 60-90 days are required for successful treatment. 

The handling of bulls should be similar to that advised for 
cows. With a gravity apparatus, we irrigate the sheath of the 
penis daily with 0.75% bacillol. We use, for inserting into the 
sheath, a pure gum horse catheter. We direct that after the in- 
sertion, the preputial orifice be held shut until the sheath is 
fully distended and all mucous folds obliterated, so that the 
fluid shall reach every part. 

In the presence of pyometra, the vaginal irrigations with 
warm bacillol solutions seems to favor the normal contraction of 
the uterine walls and emptying of the cavity. This may be 
aided by massaging the distended, paretic organ, from before, 
backwards, through the rectum. As soon as the ovaries can be 
reached per rectum, any cysts or persistent yellow bodies should 
be crushed out. When an affected cow calves or aborts, the 
uterine cavitj' should at once receive careful attention. It 
should be thoroughly irrigated with the warm, 0.75% bacillol 
solution, three or four times daily till the afterbirth comes away. 
When the afterbirth is easily detached, it may be manually re- 
moved. 

After the expulsion of the afterbirth, the uterine cavity should 
be irrigated once or twice daily as long as the cervical canal re- 
mains open and uterine discharge continues. Any neglect in 
this respect may lead to a chronic uterine infection to be followed 
by sterility or abortion. For a full discussion of retention of 
the afterbirth see page 791. 

The prophylaxis of the disease is important and economic. In. 
introducing new animals into a sound herd, precautions should 



1 1 1 2 Veterinary Obstetrics 

be taken against the entrance of the infection. There is every 
reason why the buyer of cattle should resort to the same expedi- 
ent in guarding his interests as has long been common among 
horsemen — a veterinary examination for soundness. In cows 
and heifers, the disease is usually easily detected. At present, 
any examination of a bull may be unreliable. Of more value are 
the examinations of the cows which he has recently served. A 
bull calf, which has not been used, but has been kept in a herd 
where the disease exists, should be regarded as dangerous for 
introduction into a clean herd until subjected to quarantine with 
daily disinfection. 

The prevention of the extension of the disease to heifer calves 
in an infected herd is apparently a simple matter. In Herds, 
66% of all females are diseased, while of virgin heifers but 17% 
are affected. In Herd 2, the percentage of infection was 61 
among heifer calves. In Herd 2, during the time elapsing be- 
tween inspection in January and inspection on May 23rd, each 
heifer recorded as sound by the first inspection had become in- 
fected, without having been bred. From our investigations, it 
appears highly probable that the disease is transmitted to heifer 
calves largely by grooming with utensils befouled by use on 
diseased animals. Caretakers may carry the disease to calves 
in other ways, which prudence would suggest should be avoided. 
If practicable, they should be kept in separate stables or en- 
closures, and not groomed with utensils used on diseased animals. 
They should on no account be .served by suspicious bulls. 

In Herd 2, are some very young infected heifer calves which 
have not been groomed. Having drawn the attention of the 
manager to the dangers of grooming with infected uten.sils, no 
further grooming occurred. Still the calves were infected. In- 
quiries revealed the fact that the calves had suffered from 
diarrhae and the feces had been washed from the tail, vulva, etc, 
with a sponge used for sponging away the muco-purulent vulvar 
discharges of neighboring diseased cows. The sponge had been 
used in water containing a little creolin, far too little to disinfect, 

The bull is the fundamental transmitter of the disease, through 
copulation. A herd bull should not be allowed to serve strange 
cows, unless they are regarded sound. by a competent examiner. 
Even then, it is good economy to regard the cow as suspicious 
and disinfect the prepuce and penis of the bull immediately after 
coition. 



Granular Veneral Disease of Cows 1113 

When the disease exists in a herd, all breeding should be sus- 
pended during treatment. When it is deemed safe to resume 
breeding, the sheath and penis of the bull should be disinfected 
by irrigating, immediately before and after each service, as ad- 
vised above. The vulva of the cow should be carefully inspected 
daily after service, and antiseptic irrigations resumed at any 
time conditions may so indicate. 

The attitude of veterinary sanitary authorities toward the dis- 
ease in this country is yet to be determined. In Europe, many 
investigators recommend listing it among the serious infectious 
diseases, and controlling it by quarantine. 

It is to be hoped that a careful study of this malady will now 
be made by numerous practitioners, and its nature and best mode 
of handling promptly determined. 



APPENDIX II. 



THE VENEREAL DISEASE OF SHEEP. 

Without having been aware of its existence in America, we 
have inserted on page io8, a brief description of a venereal dis- 
ease occuring in sheep in Great Britain. 

According to a recent communication from Mohler of the 
Bureau of Animal Industry, this venereal disease of sheep pre- 
vails in certain portions of the sheep raising section of the West, 
especially in Montana and Wyoming. His investigations, as yet 
unpublished, indicate that the bacillus necrophorus is the causa- 
tive agent, and that the infection may be transmitted to healthy 
sheep by injecting pure cultures of this organism into the sheath 
or vulva, if a slight abrasion or catarrhal condition of the mucosa 
is present. The disease is apparently identical to that described 
by McFadyean, Flook, and Williams, and is most frequently ob- 
served in this country during the fall, winter and early spring. 
It is not uncommonly found to co-exist with similar ulcerations 
and wart-like crusts on the legs, lips and muzzles of sheep 
(necrotic dermatitis). The latter affection is known locally as 
lip and leg ulceration. Bucks with infected lips are said to 
contaminate the vulvae of ewes by nosing them, and the sheath 
and penis of the bucks in turn become involved by copulation. 

The treatment will be found very efficacious if the disease is 
handled like contagious abortion. The healthy sheep should be 
separated from the diseased, and the sheath and vagina irrigated 
with mild antiseptic solutions, while the external ulcers should 
be covered with vaseline coutaining five per cent carbolic acid. 



ERRATA. 

On page 129, in description of Fig. 14, for "CC," read "UC' 
On page 687, for "Vaginal Hysterectomy." read " Vaginal 
Hysterotomy." 

On page 855, Page Heading, for "Evorsion," read "Eversion." 
On page 244, 3d line, for " Under," read " Under." 
On page 149, Page Heading, for "Phymosis," read'Taralysis." 
On page 104, Title, for "Granulamota," read "Granulomata." 
On page 141, Heading, for "Overwork," read "Over- feeding." 



INDEX. 



Abnormalities in the Development of 
the fetus, 727. 

Abnormal Presentations and Positions 
of the Fetus, 753. 

Abdominal Floor, Edema of the, 436. 

Aberrations and Anomalies in the De- 
velopment of the Fetus, 744. 

Abortion, 466. 

Abortion, Accidental, 467. 

Abortion, Artificial, 67.S. 

Abortion, Enzootic, 473. 

Abortion from Infectious Diseases of 
the Mother, 473. 

Abortion, Granular Venereal Disease 
as Cause, 11 98. 

Abortion, Infectious, 474. 

Abortion, Infectious, of Cows, 495. 

Abortion, Infectious, of Mares, 477. 

Abortion, Sporadic, 467. 

Abscesses, Actinomycotic, of the 
Broad Ligament of the Uterus, 113. 

Abscesses, Peri- Vaginal, 901. 

Abscess, Uterine, S96. 

Absence of Estrum, 198. 

Acardia, 289. 

Accessory Organs of Reproduction, 
The, 3. 

Accidental Abortion, 467. 

Actinomycosis of the Broad Liga- 
ments of the Uterus, 113. 

Actinomycosis of the Genital Organs, 

113- 

Actinomycosis of the Prepuce, 113. 

Actinomycosis of Udder, 972. 

Acute Endo-Metritis in the Mare, S74. 

Acute Infections of the Mammae, 940. 

Acute Mammitis in Cow, 940. 

Acute Metritis, 872. 

Acute Metritis in Cow, 878. 

Acute Metritis in Smaller Animals, 
884. 

Acute Metro-Peritonitis in Cow, 878. 

Acute Metro-Peritonitis in the Mare, 
877. 

Adhesions of Penis and Prepuce, 
Sterility from, 148. 

Afterbirth, Retained, 791. 

Agalactia, Infectious, of Cows, 965. 

Agalactia in Goats and Sheep (In- 
fectious), 977. 

Age as a Cause of Sterility, 150. 

Allantois, Dropsy of the, 424. 

Allantois, 1 he, 353. 

Amaurosis of Pregnancy, 435. 

Amnion, Drops)' of the, 424. 



Amnion, The, 347. 

Amputation at Humero-Radial Articu- 
lation, 64S. 

Amputation, Intra Pelvic, of the Pos- 
terior Limbs, 653. 

Amputation of Anterior Limbs, Sub- 
cutaneous, 645. 

Amputation of the Fetal Head, 642. 

Amputation of Head and Neck, 644, 

Amputation of Posterior Limbs at 
Tarsus, 651. 

Amputation of Uterus, 844. 

Anomalies in Fecundation and Gesta- 
tion, 413. 

Anterior Limbs, Dystokia from De- 
viation of, 753. 

Anasarca of the Fetus, 740. 

Anatomical Defects of New-Born, 
1046. 

Anatomy, Obstetric, 3. 

Anorchidy, 125. 

Ante-Partum Prolapse of the Vagina, 

449 
Anterior Presentation, Dystokia in, 

753- 
Anus, Imperforate, 1064. 
Apparatus for Obstetric Work, 576. 
Application of Traction to the Fetus, 

586. 
Apoplexy; Parturient, of the Cow, 

920 
Apthous Venereal Disease, 95. 
Arrested Development of the Penis, 

Sterility from, 144. 
Arteries of the Fetus, The, 319. 
Artificial Abortion, 678. 
Artificial Impregnation, 279. 
Artificial Respiration in New-Born 

Animal, 557. 
Ascites of Fetus, 739. 
Asphyxia in New-Born Animal, 557, 

1035- 
Ass, Duration of Pregnancy in, 398. 
Atresia of Anus, 1064. 
Atresia of Body Openings, 1066. 
Atresia of Cervix Uteri, 685. 
Atresia of Posterior Nares, 1065. 
Atresia of Teats, 993. 
Atrophy of the Ovaries, Senile, 245. 
Azoospermie, 125. 
Azoospermie from Systemic Disease, 

137- 
Bacteriaemia of Calves, 1033. 
Bands, Obstetric, 576. 
Beschalseuche, 73. 



iii6 



Index 



Bicornual Pregnancy, 716. 

Birth, Management of Normal, 538. 

Birth, Premature, 466. 

Birth, Still, 466. 

Bitch, Duration of Pregnancy in, 398. 

Bitch, Mammitisin, 978. 

Bitch, Pyometra in, 895. 

Bitch, Nymphomania in, 244. 

Bladder, 334. 

Bladder, Eversion of, 855. 

Bladder, Injuries to, during Coition, 
58. 

Bladder, Prolapse of, S55. 

Bladder, Prolapse of, through Vagina, 
822 

Bladder, Rupture of, 820. 

Blastoderm, 284. 

Blastodermic Vesicle, 284. 

Body Cavity, 287. 

Botryomycosis of the Udder, 974. 

Brain, Hernia of, 1069. 

Brain, The, 291. 

Breech Presentation, 783. 

Broad Ligaments of the Uterus, Ac- 
tinomycosis of the 1 13. 

Broad Ligaments, The, 21. 

" Broken Penis " as a cause of Ster- 
ility, 147. 

Bursattee of the Penis and Prepuce, 
III. 

Caesarian Section, 663. 

Calcareous Degeneration of Ovaries 
as Cause of Sterility, 158. 

Calculi, Milk, 987. 

Calf Septicsemia, 1033. 

Calves, Bacterisemia of, 1033. 

Calves, Infectious Diarrhea of, 1028. 

Calves, Septic Pleuro-Pneumonia of, 
1032. 

Campylorrhachis, 744. 

Canal, Cervical, 26, 

Castration, Influence of upon the 
milk, 230. 

Castration in Sterility, 21S. 

Cat, Duration of Pregnancy in, 398. 

Cat, Pyometra in, 895. 

Care of New-Born Animal, 550. 

Care of the Parturient Animal, 550. 

Care of Umbilic Cord, 558. 

Carnivora, Duration of Pregnancy in, 
398. 

Catarrh, Infectious Vaginal, of Cattle, 
97, 1075. 

Cattle, Apthous Venereal Disease of, 

95- 
Cattle, Granular Venereal Disease of 

97, 1075, 
Cattle, Infectious Vaginal Catarrh of, 

97, 1075. 
Cattle, Venereal Diseases of, 95. 



Cattle, Vesicular Exanthem of, 95. 

Cellulitis, Contagious, 68. 

Cellulitis Epizootic, 68. 

Cephalotom}', 643. 

Cervical Canal of the Uterus, 26. 

Cervix Uteri 26. 

Cervix Uteri, Atresia of, 685. 

Cervix Uteri, Induration of, 685. 

Cervix LTteri, Rigidity of, 682. 

Cervix Uteri, Spasm of, 682. 

Chisels, Obstetric, 605. 

Chorion, Rupture of in Parturition, 

548. 
Chorion, The, 355. 
Chronic Metritis in Cow, 894. 
Chronic Metritis in Mare, 885. 
Circulation, The Fetal, 328. 
Circulatory System, The, 319 
Clavicles in Pig, 345. 
Cleft Palate, 298. 
Clothing, Obstetric, 613. 
Clitoris, Prepuce of the, 35. 
Clitoris, The, 34. 
Coelum, The, 287. 
Coital Exanthema, 92. 
Coition, 49. 

Coition, General Infections of, 64. 
Coition, Injuries to the Bladder from, 

58- . . 

Coition. Injuries to the Penis during, 

60. 
Coition, Injuries to the Vagina from, 

56. 
Coition, Physical Injuries of, 50. 
Coition, Specific Infections of, 73. 
Coition, Strangulated Hernia from, 

62. 
Coition, The Dangers and Infections 

of, 50. 
Columns, Egg, 44. 
Congenital Defects of the Ovaries as 

a cause of Sterilit_v, 155. 
Congenital Tumors of Testicles, 125. 
Construction of Obstetric Instru- 
ments, 608. 
Contagious Cellulitis, 68. 
Contractures of Fetal Extremities, 

746. 
Control of Expulsive Efforts, 619. 
Control of the Patient in Dystokia, 

615. 
Contusion of the Guteal Nerves, 867. 
Contusion of the Obturator Nerves, 

868. 
Contusion of the Lumbo-Sacral 

Nerves, 866. 
Copulation, 49. 
Copulation, Fal.se, 53. 
Copulation, Sterility from Physical 

Inability to Perform, 144. 



Index 



II 17 



Cords, Application of to Inferior 
Maxilla of Fetus, 581. 

Cords, Applications of to Limbs and 
Head of Fetus, 579. 

Cords, Obstetric, 576. 

Corpus LutciuH, 16. 

Corpus i.uteum, Dislodgement of, for 
Sterility, 227. 

Corpus Luteum, Hypertrophy of , 229. 

Corpus Luteum, Persistent, 229. 

Cow, Acute Mammitis in, 940. 

Cow, Acute Metritis in, 87S. 

Cow, Chronic Metritis in, 894. 

Cow, Duration of Pregnancy in, 398. 

Cow, Granidar Venereal Disease of 
the, in America, 1075. 

Cow, Infectious Abortion of the, 495. 

Cow, Infectious Agalactia of the. 965. 

Cow, Infectious Mammitis of the, 965. 

Cow, Metro- Peritonitis in, 87S. 

Cow, Retained Placenta in, 793. 

Cow-Pox, Mammitis of, 968. 

CoxjE, The, 5. 

Crj'ptorchidy, Sterilit}' from, 126. 

Cj'anosis, 1068. 

Cj'clops, 291 

C^'stic and Cysto-Fibrous Degenera- 
tion of Ovaries as Cause of Sterility, 
161. 

Cystitis, 900. 
.Cysts, Dermoid, of the Testicles, 125. 

Cysts of Fetal Organs, 740. 

Dangers and Infections of Coition, 

The, 50. 
Death of Fetus, 460. 
Death of Fetus, Causes of, 547. 
Death of Fetus, Diagnosis of, 546 
Death of Fetus, Dystokia from, 733. 
Debilitating Diseases and Overwork, 

Sterility from, 137. 
Decapitation, 642. 
Decomposition of Fetus, 463. 
Defective Secretions of the Accessory 

Glands, Sterility from, 144. 
Defects, Anatomical, of New-Born, 

1046. 
Defects and Diseases of the Ovaries 

as Cause of Sterility, 155. 
Degeneration of Ovaries, Cj'Stic and 

C^'sto- Fibrous, as Cause of Sterility, 

161. 
Degeneration of Testicles, Spontane- 
ous ; Sterility from, 135. 
Dermatitis of the Udder, 988. 
Dermoid Cysts of the Testicles, 125. 
Destruction of the Pelvic Girdle, 649. 
Detruncation, 648. 
Development of the Organs of Special 

Sense 296. 



Development of the Urino-Genital 

System, 332. 
Deviation of Anterior Limbs, Dys- 
tokia from, 753. 
Deviation of the Uterus 692. 
Deviations of the Head and Neck, 

Dystokia from, 765. 
Diagnosisof Multiple Pregnancy, 401. 
Diaphragm, Rupture of, 821. 
Diarrhea, Infectious, of Calves, 1028. 
Diarrhea, Sporadic, 1022. 
Digestive Apparatus, Functions of 

the, 304. 
Discus Pyoligerus, 14, 46. 
Diseases of Fetus and its Membranes, 

460. 
Diseases of Pregnant Animal, 421. 
Diseases, Venereal, 73, 1075. 
Diseases of the Fetus, 736. 
Diseases of New-Born Animal, 1003. 
Diseases of the Mammary Glands, 939. 
Diseases of the Fetus, Dystokia from, 

727. 
Dislodgement of Corpus Luteum for 

Sterility, 227. 
Displacements of Uterus, Dystokia 

from, 692. 
Dog, Venereal Disease of the, 104. 
Dorsal Transverse Presentation, 786. 
Dorso-Ilial Position, Dystokia from, 

7S0. 
Dorso-Ilial position of Fetus, 753. 
Dorso-Pubic Position, Dystokia of, 

780. 
Dorso-Pubic Position of Fetus, 753. 
Double and Triple Monstrosities, 748. 
Dourine, 73. 

Dress of the Operator, 613. 
Dropsy of the Amnion and Allantois, 

424. 
Dropsy of the Uterine Cavity, 430. 
Dropsy of the Uterus, 430. 
Ducts, the Muellerian, 19. 
Duration of Pregnancy, 395. 
Dystokia, 568. 

Dystokia, Apparatus for, 576. 
Dystokia, Artificial Abortion as pre- 
ventive, 678. 
Dystokia, Control of Patient in, 615. 
Dystokia, Equipment for, 576. 
Dystokia, Fetal, 568, 714. 
Dystokia From Defective Expulsive 

Powers, 673. 
Dystokia From De^dation of Anterior 

Limbs, 753. 
Dystokia From Deviations of the 

Head and Neck, 765. 
Dystokia From Displacements of the 

Uterus, 692. 



Iii8 



Index 



Dystokia From Interlocking of Ma- 
ternal and Fetal Pelves, 773. 

Dystokia From Pelvic Constriction, 
674. 

Dystokia From Pelvic Fractures, 675. 

Dystokia From Rachitis, 674. 

Dystokia From Retention of Hind 
Limbs, 7S1. 

Dystokia From Tumors of Genital 
Passages, 690. 

Dvstokia, Instruments for, 576. 

Dystokia Maternal, 56S, 673. 

Dystokia of Anterior Presentation, 

753- 
Dystokia of Anterior Presentation 

with. Forward Extension of Hind 

Limbs, 776. 
Dystokia of Posterior Presentation, 

780. 
Dystokia of Twins, 752. 
Dystokia, Position of Patient in, 615. 
Dystokia, The Examination of the 

Patient in, 623. 
Dystokia, The General Handling of, 

627. 
Dysentery, Infectious of Calves, 102S. 
Dyseuteria Neonatorum, 1022. 
Dysenterj' of New-Born, 1022. 
Dysentery, Sporadic, 1022. 

Ear, Dermoid Cyst of, 301. 

"Ear Tooth," 303. 

Ear, The, 300. 

Eclampsia, Parturient, of the Mare, 
914. 

Eclampsia, Puerperal. See Puerperal 
Eclampsia. 

Eclampsia, Puerperal in the Sow, 936. 

Eclamptic Diseases, Puerperal, 910. 

Edema of the Abdominal Floor, 436. 

Edema of the Ovaries as a Cause of 
Sterility, 160. 

Edema of Udder, 979. 

Egg Columns, 44. 

Egg, Segmentation of the, 281. 

Embr\'0, Formation of the 286. 

Embryology, 281. 

Embrj'Otomes, 602. 

Embrvotomy, 641. 

Embryotom)', Exercises in, 661. 

Embrvotomy Instruments, 599. 

Embryotomy in the Anterior Presen- 
tation, 642. 

Embryotomy in the Posterior Pre- 
sentation, 651. 

Embryotomy Knives, 599. 

Embryotomy Under Special Condi- 
tions, 660. 

Emphysema of Fetus, 733. 

Endo-Metritis acute )in the Mare, 874. 



Engorgement, Mammary, 979. 

Enzootic Abortion from Infectious 
Diseases of the Pregnant Animal, 
473- 

Epiblast, 2S5. 

Epididj'mitis, Sterilit)' from, 130. 

Epizootic Cellulitis, 68. 

Equine Syphilis, 73. 

Equipment for Obstetric Work, 576. 

Eruptive Venereal Disease of the 
Horse, 92. 

Estrum, 48. 

Estrum, Absence of, 198. 

Estrum, Relation of to Ovulation 
Fertilization and Menstruation, 116. 

Eversion of the Bladder, S55. 

Eversion of Uterus, 823. 

Eversion of Vagina, 848. 

Evisceration, 658. 

Ewe, Milk Disease in, 937. 

Ewe, Parturient Paresis in, 937. 

Ewes, Gangrenous Mammitis of, 976. 

Ewes, Infectious Agalactia in, 977. 

Ewes, Infectious Abortion of, 507. 

Examination of the Female for Ster- 
ility, 234. 

Examination of the Male for Ster- 
ility, 151. 

Examination of the Patient in Dys- 
tokia, 623. 

Examination of Udder, 968. 

Exanthem, Vesicular, 95. 

Excess of Volume of the Fetus, 727. 

Excessive Erection of Penis, Sterility 
from, 146. 

Excessive Sexual Use, Sterility from, 
142. 

Exercises in Embryotomy, 661. 

Exercises in Mutations, 661. 

Exomphalus, 1046. 

Expulsive Efforts, Control of, 619. 

Expulsion of the Fetal Membranes, 
527- 

Expulsive Powers, Inadequate, as a 
Cause of D3'stokia, 673. 

Extension and Adjustments of the 
Fetal Extremities, 636. 

Extensor Pedis Longus Tendons, 
Rupture of in Foals, 1070. 

Extraction, Forced, 640. 

Extractor, Pflanz, Obstetric, 604. 

Extra-Uterine Pregnancy, 415. 

Extremities, Fetal, Adjustment of, 
636. 

Eye, The, 298. 

False Copulation, 53. 
False Corpus Luteum, 16. 
Fecundation, Anomalies in, 413. 
Feeding of New-Born, 564. 



hid ex 



1119 



Feet and Limbs, Painful Diseases of, 
as a Cause of Sterility, 150. 

Female, Sterility of, 151. 

Fertilization, 1 15. 

Fertilization, Relation of, to Estrum, 
Ovulation and Menstruation, 116. 

Fetal Circulation, The, 328. 

Fetal Dystokia, 568, 714. 

Fetal Emphysema, 727. 

Fetal Extremities, Contractures of, 
746. 

Fetal Envelopes, Retention of the, 
791. 

Fetal Extremities, Extension and Ad- 
justment of, 636. 

Fetal Membranes and the Placenta, 
347- 

Fetal Membranes, Diseases of the, 460. 

Fetal Membranes, Expulsion of, 527. 

Fetal Organs, Cysts of, 740. 

Fetus, Anasarca of, 740. 

Fetus, Application of Traction to, 
586. 

Fetus, Ascites of, 739. 

Fetus, Causes of Death of, 547. 

Fetus, Changes of Position of, in 
Dystokia, 631. 

Fetus, Death of, 460, 733. 

Fetus, Development of, in an Abnor- 
mal Position, 716. 

Fetus, Diagnosis of Death of, 546. 

Fetus, Diseases of, 460, 736. 

Fetus, Emphysema of, 727. 

Fetus, Excess of Volume of the, 727. 

Fetus, Hydrothorax of, 739. 

Fetus, Masceration of, 463. 

Fetus, Mummification of the, 461. 

Fetus, Mutations of, in D3'stokia, 
631. 

Fetuses, Number of, 399. 

Fetus, Presentations of the, 530. 

Fetus, Position of, in Uterus, 379. 

Fetuses, Position of, in Multiple 
Pregnancy, 402. 

Fetus, Positions of the, 530. 

Fetus, Putrid Decomposition of, 463. 

Fetus, Repulsion of, 632. 

Fetus, Rotation of, 632. 

Fetus, Transverse Development of 
the, as a Cause of Dystokia, 716. 

Fetus, Tumors of the, 741. 

Fetus, Version of, 634. 

Finger Knives, 599. 

Fissure of the Palate, 1067. 

Fistula, Milk, 985. 

Fistula, Vesico- Vaginal, 863. 

Foramen Ovale, Persistent, 106S. 

Follicle, Graafian, 46. 

Forced Extraction, 640. 

Forceps, Obstetric, 586. 



Formation of the Embryo, 286. 

Forward Extension of Hind Limbs, 
Dj'stokia from in Anterior Presen- 
tation, 776. 

Fractures, Pehdc, Dystokia from, 675. 

Freemartins, Sterility of, 156. 

Furunculosis of the Udder, 990. 

Gangrene of Mammae, 946. 
Gangrenous Mammitis of Ewes, In- 
fectious, 976. 
Gastro-Hysterotomy, 663. 
" Gelber Gait " of Cows, 965. 
General Infectious of Coition, 64. 
Generative Organs, The, 11. 
Genital Cells, Wandering of, 414. 
Genital Horse Pox, 92. 
Genital Organs, Actinomycosis of 

the, 113. 
Genital Organs, Wounds and Injuries 

of, 812. 
Germinal Layers, 284. 
Germinal Spot, 45. 
Gestation, 369. 
Gestation, Anomalies in, 413. 
Gluteal Nerves, Contusion of, 867. 
Gluteal Paralysis, 867. 
Goats, Infectious Abortion of, 507. 
Goats, Infectious Agalactia in, 977. 
Goat, Nymphomania in the, 244. 
Goat, Parturient Paresis in, 937. 
Goats, Venereal Disease of, 1 10. 
Graafian Follicle, 46. 
Graafian Follicle, Maturation of the 

44. 
Granular Venereal Disease of Cattle, 

97- 
Granulomata, Venereal, of the Dog, 

104, 1075. 
Gravid L'terus, Form of, 374. 
Gravid Uterus, Hemorrhage from the, 

457- 
Gravid Uterus, Rupture of, 417, 447. 
Gubernaculum Testis, 336. 

Halters, Obstetric, 577. 

Handling of Dystokia, General, 627. 

Head and Neck, Dystokia from De- 
viations of the, 765. 

Hematoma of Vulva, S64. 

Hemorrhage from the Gravid Uterus, 
457- 

Hemorrhage, Post-Partum, 812. 

Hemorrhage, Umbilic, 1037. 

Hemorrhages in the Udder, 983. 

Hermaphroditism, Sterility from, 
157- 

Hermaphrodites, Sterility of, 127. 

Hernia of Brain, 1069. 

Hernia Cerebri, 294, io6g. 



II20 



Index 



Hernia, Inguinal, 1059, 

Hernia, Navel, 1046. 

Hernia, Scrotal, 1059. 

Hernia, Strangulated Inguinal, from 

Coition, 62, 
Hernia of Uterus, 445, 692. 
Hernia, Umbilic, 1046. 
Hock, Amputation at the, 651. 
Hooks, Long Cutting, 602. 
Hooks, Obstetric, 582. 
Hoise, Eruptive Venereal Disease of 

the, 92. 
Horse Pox, genital, 92. 
Hybrids, Sterility of, 127, 157. 
Hj'drallantois, 424. 
Hydrocele, Sterility from, 136. 
Hydrocephalus, 293, 736. 
Hj'drometra, 430. 
Hydrops Amnii, 424. 
Hydrothorax of Fetus, 739. 
Hygiene of Pregnant Animals, 404. 
Hymen, The, 32. 

Hypertrophy of Corpus Luteum, 229. 
Hypoblast, 285. 
Hysterectomy, 669. 
Hysterotomy', Vaginal, 687. 
Hysterocele, 445, 692. 
Hysterotomy, Gastro-, 663. 

Idleness and Overfeeding, Sterility 
from, 138. 

Ilium, The, 5. 

Imperforate Anus, 1064. 

Imperforate Vulva, 1064. 

Impregnation, Artificial, 279. 

Induration of Cervix Uteri, 6S5. 

Infection During Obstetric Opera- 
tions, The Prevention of, 620. 

Infection, Purulent of the Navel, 
1005. 

Infection Pysemic, 902. 

Infections of Coition, General, 64. 

Infections of Coition, Specific, 73. 

Infections of the New Born, 1003. 

Infections. Puerperal, S71. 

Infectious, Abortion, 474. 

Infectious Abortion, Granular Vene- 
real Disease as Cause, 1098. 

Infectious Abortion of Cows, 495. 

Infectious Abortion of Goats, 507, 

Infectious Abortion of Mares, 477. 

Infectious Abortion of Sheep, 507. 

Infectious Abortion of Swine, 507. 

Infectious Agalactia of Cows, 965. 

Infectious Agalactia of Goats and 
Sheep, 977. 

Infectious Diarrhea of Calves, 1028. 

Infectious Diseases as a Cause of Ste- 
rility, 151. 



Infectious Diseases of Pregnant Ani- 
mals as Cause of Abortion, 473. 

Infectious Gangrenous Mammitis of 
Ewes, 976. 

Infectious Granular Vaginitis of 
Cows, 97, 1075. 

Infectious Mammitis of Cow, 965. 

Infectious Vaginal Catarrh of Cattle, 
97, I075- 

Inferior Maxilla, Securing of, with 
Cord, 638. 

Inflammation of Ovaries, as a Cause 
of Sterility, 158. 

Inflammation of the Penis, Sterility 
from, 147. 

Influenza, Rheumatic, 68. 

Inguinal Hernia, 1059. 

Inguinal Hernia, Strangulated, from 
Coition, 62. 

Injuries, Physical of Coition, 50. 

Injuries to the Bladder, during 
Coition, 58. 

Injuries to the Penis during Coition, 
60. 

Instruments, Construction of Obste- 
tric, 60S. 

Instruments for Obstetric Work, 576. 

Instruments for Section of Fetus, 599. 

Interlocking of Maternal and Fetal 
Pelves, Dystokia from, 773. 

Intestine, Prolapse of, through 
Uterus or Vagina, 821. 

Intestines, Rupture of, 820. 

Intra-Pelvic Amputation of Posterior 
Limbs, 653. 

Introductory, i. 

Inversion of Uterus, 823. 

Involution of the Uterus, 527. 

Ischium, The, 6. 

Jaw, Securing of the, with Cord, 638. 

Kidneys, Ureters, and Bladder, 334. 
Knives, Embryotomy, 599. 
Knives, Finger, 596. 

Lambs, Pustular Eruptions on Lips 

of, 976. 
Laminitis, Parturient, 907.- 
Laminitis, Puerperal, 907. 
Ligaments. The Broad, 21. 
Ligament, The Round of the Uterus, 

26. 
Limbs, Embryology of, 341. 
Liver, The, 318. 
Long Cutting Hooks, 602. 
Lower Jaw, Securing of by Means of 

Cord, 638. 
Lumbo-Sacral Ner\'es, Contusions 

of, 866. 



Index 



Lumbar or General Paralysis, Steril- 
ity from, 149. 

Lympho-Sarcoma, Venereal, of the 
Dog, 104. 

Maladie du Coit, 73. 

Male Animal, Sterility of the, 121. 

Male Reproductive Organs, 335. 

Malignant Tumors of Genital Pas- 
sages, 690. 

Mammae, Exanthema of, 96S. 

Mammffi, The, 35. 

Mammary Botryomycosis, 974. 

Mammary Engorgement, 979. 

Mammary Actinomycosis, 972. 

Mammary Hemorrhages, 983. 

Mammarj- Strangles in Mare, 973. 

Mammary Toxaemia, 946. 

Mammary Tumors, 981. 

Mammitis, 940. 

Mammitis of Bitch, 978. 

Mammitis of Cow- Pox, 96S. 

Mammitis of Cow, Acute, 940. 

Mammitis of Cows, Infectious, 965. 

Mammitis of Ewe, Infectious, 976, 977. 

Mammitis in the Mare, 973. 

Mammitis of Swine, 978. 

Mammitis, Tubercular, 970. 

Management of Normal Parturition, 
538. 

Mastitis, See Mammitis. 

Mare, Acute Endo-Metritis in, 874. 

Mare, Acute Metro- Peritonitis in, 877. 

Mare, Chronic Metritis in, 885. 

Mare, Duration of Pregnancy in. 397. 

Mares, Infectious Abortion of, 477. 

Mare, Nymphomania in the, 234. 

Mare, Parturient Eclampsia of the, 
914. 

Mare, Retained Placenta in, 808. 

Masceration and Putrid Decomposi- 
tion of the Fetus, 463. 

Masturbation, Sterility from, 143. 

Mastitis, 940. 

Maternal Dystokia, 568, 673. 

Maturation of the Graafian Follicle, 
44-. 

Maxilla, Inferior, Securing of with 
Cord, 638. 

Meatus Urinarius, 34. 

Meconium, Retention of, 1041. 

Mega/omelus Perissodactylus, 345. 

Membrane, Vitelline, 46. 

Menstruation, 114. 

Menstruation, Excessive in Granular 
Venereal Disease, 1077. 

Menstruation, Relation of to Estrum, 
Ovulation and Fertilization, 116. 

Mesoblast, 285. 

Metritis, Acute, 872. 

Metritis, Acute, in the Cow, 878. 



Metritis, Acute, in the Mare, 877. 

Metritis, Acute, in Smaller Animals, 
884. 

Metritis, Chronic, 8S5. 

Metritis, Chronic, as a Cause of Ster- 
ility, 222. 

Metritis (Chronic) in Cow, 894. 

Metritis ( Chronic ) in Mare, 885. 

Metro-Peritonitis (Acute) in the Cow, 
878. 

Metro-Peritonitis in the Mare, 877. 

Metrorrhagia, 457. 

Milk Calculi, 987. 

Milk Disease of Sheep, 937. 

Milk Fever, 920. 

Milk Fistulse, 985. 

Milk, Influence of Castration Upon 
the, 230. 

Milk Stones, 987. 

Milk, Uterine, 25. 

" Mole" 2S9. 

Monstrosities, 367. 

Monstrosities, Double and Triple, 748. 

Muco-Enteritis, 68. 

Muellerian Ducts, The, 19. 

Muellerian Ducts, The; The Ovi- 
ducts, Uterus, and Vagina, 19. 

Multiple Pregnancy, Diagnosis of, 
401. 

Multiple Pregnancy, Position of Fe- 
tuses in, 402. 

Mummification of the Fetus, 461. 

Mutation, 631. 

Nares, Posterior, Atresia of, 1065. 

Navel Cord, Rupture of, 558. 

Navel Hernia, 1046. 

Navel, Purulent Infection of the, 1005. 

Nerves, Contusions of the Lumbo- 
sacral, 866. 

Nervous System, The, 288. 

Neural Groove, 288. 

New-Born, Anatomical Defects of, 
1046. 

New-Born, Artificial Respiration in 
the, 557. 

New-Born, Asphyxia in the, 557. 

New-Born, Care of the, 550. 

New-Born, Diseases of the, 1003. 

New-Born, Feeding of, 564. 

New-Born, Infections of the, 1003. 

New-Born, Tetanus of the, 1021. 

Normal Parturition, 509. 

Normal Parturition, Management of, 
538. 

Nose, The, 296. 

Nostrums and Panaceae Against 
Sterility, 273. 

Nymphomania as Cause of Sterility, 
161. 



Index 



Nymphomauia, General Symptoms 

of, 172. 
Nymphomania in the Bitch, 244. 
Nymphomania in the Goat, 244. 
Nymphomania in the Mare, 234. 
Nymphomania in the Sow, 244. 

Obstetric Anatomy, 3. 

Obstetric Bands, 576. 

Obstetric Chisels, 605. 

Obstetric Cords, 576. 

Obstetric Cutting Hooks, 602. 

Obstetric Forceps, 586. 

Obstetric Halters. 577. 

Obstetric Hooks, 582. 

Obstetric Instruments, Construction 
of, 608. 

Obstetric Operations, 631. 

Obstetric Operations, The Prevention 
of Infection During, 620. 

Obstetric Outfits, 611. 

Obstetric Physiology, 40. 

Obstetric Repellers, 595. 

Obstetric Saws, 605. 

Obstetric Scalpels, 600. 

Obstetric Shears, 604. 

Obstetric Spatulas 608. 

Obstetric Work, Equipment For, 576. 

Obturator Nerves, Contusion of, 858. 

Obturator Paralysis, 858. 

Occlusion of the Os Uteri, Sterility 
Due to, 252. 

Odontomes, 1069. 

Olfactory' Organs, The, 296. 

Omphalitis, 1005. 

Omphalocele, 1046. 

Omphalo-Phlebitis, 1005. 

Onanism, Sterility from, 143. 

Oophoritis, Sterility Due to, 158. 

Operations, Obstetric, 531. 

Operations, The Prevention of Infec- 
tion During, 620. 

Operator, Dress of the, 613. 

Orchitis and Epididymitis, Sterility 
from, 130. 

Ossa Innominata, The, 5. 

Osteomalacie, 423. 

Os Uteri, Closure of, as a Cause of 
Sterility, 252. 

Os Uteri Externum, 27. 

Os Uteri Internum, 28. 

Outfits, Obstttric, 5ii. 

Ova, Permanent, 14, 45. 

Ova, Primitive, 44. 

Ovarian Pregnancy, 415. 

Ovaries, Congenital Defects of, as a 
Cause of Sterility, 155. 

Ovaries, Cystic, and Cysto-fibrous 
Degeneration of, as Cause of Steril- 
ity, i5i. 



Ovaries, Edema of, as a Cause of Ste- 
rility, 160. 

Ovaries, Inflammation of, as a Cause 
of Sterility, 15S. 

Ovaries, Senile Atrophy of the, 245. 

Ovaries, Sterility due to Defects and 
Diseases of, 155. 

Ovaries, Sterilitv from Tuberculosis 
of,,i5S. 

Ovaries, Tumors of, as a Cause of 
Sterility. 159. 

Ovaries, The, 11. 

Overfeeding, Sterility from, 13S. 

Overwork, Sterility from, 137. 

Oviducts, Sterility Due to Diseases 
of, 247. 

Oviducts, The, 22. 

Ovulation, 44. 

Ovulation, The Relation of, to 
Estrum, Fertilization and Menstru- 
ation, 116. 

Palate, Cleft, 298, 1067. 

Palate, Fissure of the, 1067. 

Pancreas, The, 318. 

Paralysis, Gluteal, 867. 

Paralysis, Obturator, 868. 

Paralysis of Penis. Sterility from, 145. 

Paralysis of Pregnancy, 430. 

Paralysis, Sterility from Lumbar or 
General, 149. 

Paraphymosis, Sterilitj' from, 149. 

Paraplegia of Pregnancy, 431. 

Paresis, Parturient. See Parturient 
Paresis. 

Paresis, Parturient, in Sheep, 937. 

Paresis, Parturient, of the Cow, 920, 

Parturient Animal, Care of, 550. 

Parturient Apoplexy in Cow, 920. 

Parturient Eclampsia of the Mare, 914. 

Parturient Laminitis, 907 

Parturient Paresis in Goat, 937. 

Parturieut Paresis in the Cow, 920. 

Parturient Paresis in Sheep, 937. 

Parturient Paresis (False) due to 
Mammary Infection, 945. 

Parturient Paresis , Pathology of the, 
791. 

Parturition, Management of Normal, 

53S- 
Parturition, Normal, 509. 
Parturition, Symptoms of, 517. 
Pathology of the Parturient State, 791. 
Patholog}- of the Placenta, 791. 
Pathology of the Puerperal State, 791. 
Pelves, Dystokia from Interlocking 

of Maternal and Fetal, 773. 
Pelvic Constriction, Dystokia from, 

674. 
Pelvic Fractures, Dj'stokia from, 575 
Pelvic Girdle, Destruction of the, 549 



Index 



1123 



Pelvic Svmphysis, Relaxation of, S66. j 

Pelvis, the, i. 

Pendulous Udder, 98S. 

Peuis and Prepuce, Bursattee of the, 
III. 

Penis and Prepuce, Sterility from Ad- 
hesion of, 148. 

Penis, "Broken," Sterility from, 147. 

Penis, Injuries to the, during Coition, 
60. 

Penis or Prepuce, Tumors of, as a 
Cause of Sterilitv, 145. 

Penis, Sterility due to Arrested De- 
velopment of, 144. 

Penis, Sterility from Excessive Erec- 
tion of, 146. 

Penis, Sterilitj' from Inflammation of 
the, 147. 

Penis, Sterility from Paralysis of, 145. 

Peromelus Achiriis 343. 

Peromelus Aptis, 343. 

Perineum, Rupture of, 857. 

Peri Vaginal Abscesses, 901. 

Permanent Ova, 14, 45. 

Persistent Corpus Luteum, 229. 

Persistent Urachus, 1039. 

Persistent Foramen Ovale, 1068. 

Phymosis, Sterility from, 14S. 

Physical Inability- to Copulate, Ster- ' 
ility from, 144. \ 

physical Injuries of Coition, 50. \ 

Phvsiology, Obstetric, 40. 

"Pink Eye," 68. 

Placenta, (Retained', Granular Vene- 
real Disease, as Cause of, 1099. 

Placenta (Retained' in the Cow, 793. 

Placenta (Retained) in the Mare, 80S. 

Placenta (Retained) in Smaller Ani- 
mals, 811. j 

Placenta, Pathology of the, 791. 

Placenta, The, 359. 

Pleuro-Pneumonia, Septic, of Calves, 
1032. 

Polyspermia, 415. 

Posterior Limbs, Amputation of, at 
Tarsus, 651. 

Posteiior Limbs, Intra- Pel vie Ampu- 
tation of, 653. 

Posterior Nares, .atresia of, 1065 

Posterior Presentation, Dystokia of 
780. 

Posterior Presentation, Embryotomy 
in, 651. 

Post-Partum Hemorrhage, 812. 

Position of Fetus, Changes of, in 
Dj'stokia, 631. 

Positions of the Fetus, 530. 

Position of the Patient in Dystokia, 
615. 

Pox, Genital, of the Horse, 92. 



Pregnane}', 369. 
Pregnane}', Amaurosis in, 435. 
Pregnancy, Anomalies in, 413. 
Pregnane}', Bicornual, 716. 
Pregnancy, Diagnosis of Multiple, 

401. 
Pregnancy, Differentiation of from 

Various Diseases, 393. 
Pregnancy, Direct Signs of, 389. 
Pregnancy, Duration of, 395. 
Pregnancy, Extra-Uterine, 415. 
Pregnancy, Hygiene of, 404. 
Pregnancy, Objective Signs of, 387. 
Pregnancy, Ovarian, 415. 
Pregnancy, Paraplegia of, 430. 
Pregnancy, Physiologic Signs of, 385. 
Pregnancy. Physical Signs of, 387. 
Pregnancy, Position of Fetuses in 

Multiple, 402. 
Pregnancy, Positive Signs of, 389. 
Pregnancy, Rupture of Prepubian 

Tendon in, 4-,6. 
Pregnancy, Signs of, 384. 
Pregnancy, Subjective Signs of, 385. 
Pregnancy, Tubal, 416, 
Pregnancy, Twin, 399. 
Pregnant Animal, Diseases of the, 

421. 
Pregnant Animal, Hygiene of, 404. 
Pregnant Animal, Infectious Diseases 

of, as Cause of Abortion, 473. 
Pregnant Uterus, The Form of the, 

374- 

Premature Birth, 466. 

Prepubian Tendon, Rupture of, in 
Pregnancy, 436. 

Prepuce, Actinomycosis of the, 113. 

Prepuce, and Penis, Bursattee of the, 
III. 

Prepuce of the Clitoris, 35. 

Presentations of the Fetus, 530. 

Presentations, Transverse, 786. 

Prevention of [nfection During Obste- 
tric Operations, 620. 

Primitive Groove, The, 285. 

Primitive Ova, 44, 

Primitive Segments, 341. 

Primitive Streak, The, 285. 

Processus Globularcs, 296. 

Processus Vaginalis, 336 

Prognosis of Sterility, 201. 

Prolapse of the Bladder, 855. 

Prolapse of Bladder, through Vagina, 
822. 

Prolapse of Intestine through Uterus 
or Vagina, S21. 

Prolapse of Rectum, 854. 

Prolapse of Uterus, 823. 

Prolapse of Vagina, 848. 

Prolapse of Vagina, Ante- Partum, 449. 



1124 



Index 



Prolapse of Vaginal Portion of \ the 

Uterus, 449. 
Prolapse of Vaginal Portion of the 

Uterus in Sterility, 201. 
Prolapsus Vaginae in Sterility, 199. 
Pubis, The, 7. 
Puerperal Eclampsia in the Bitch, 

938- 
Puerperal Eclampsia in the Sow, 936. 
Puerperal Eclamptic Diseases, 910. 
Puerperal Infections, S71. 
Puerperal Laminitis, 907. 
Puerperal Period, Pathology of the, 

791. 
Puerperal Septicaemia, 905. 
Puerperal Tetanus, 909. 
Purulent Infection of the Navel, 1005. 
Pustular Eruptions on Lips of Lambs, 

976. 
Putrid Decomposition of Fetus, 463 
Pyaemic Infection (Puerperal), 902. 
Pyometra, 885. 

P3'ometra in Bitch and Cat, 895. 
Pyometra in Cow 894. 
Pyometra in Mare, 8S5. 
Pyometra in Sterility, 222. 
PyoSepthaemia, 1005. 

Rabbits, Venereal Disease of, no. 

Rachitis, Dystokia from, 674. 

Rectum, Prolapse of, 854. 

Relation between Estrum, Ovulation, 
Fertilization and Menstruation, 116. 

Relaxation of Pelvic Symphysis 866. 

Repellers, 595. 

Reproduction, 40. 

Reproductive Organs, The Male, 335. 

Reproduction, The Accessory Organs 
of, 3- 

Repulsion of Fetus, 595, 632. 

Retained Afterbirth, 791. 

Retained Afterbirth, Granular Vene- 
real Disease as Cause of, 1099. 

Retained Placenta in the Cow, 793. 

Retained Placenta in Smaller Ani- 
mals, 811. 

Retained Placenta in the Mare, 808. 

Retained Placenta in the Mare, Frag- 
mentary, 810. 

Retained Placenta in the Mare, Total, 
S08. 

Retention of Hind Limbs, Dystokia 
of, 781. 

Retention of Meconium, 1041. 

Retention of the Fetal Envelopes, 
791. 

Retropulsion of Fetus, 632. 

Rheumatic Influenza, 68. 

Ribs, Division of in Embryotomy, 657. 

Ricketts, Dystokia from, 674. 



Rigidity of Cervix Uteri, 682. 

Rotation of Fetus, 632. 

Round Ligamment of Testis, 336. 

Round Ligament of the Uterus, The, 
26. 

Rupture of Bladder, 820. 

Rupture of Diaphragm, 821. 

Rupture of the Extensor Pedis 
Longus Tendons in New-Born, 1070. 

Rupture of Intestines, 820. 

Rupture of Navel Cord, 558. 

Rupture of the Perineum, 857. 

Rupture of the Prepubian Tendon in 
Pregnancy, 436. 

Rupture of Sacro- Sciatic Ligaments, 
821. 

Rupture of Umbilic Cord, 558. 

Rupture of Uterus, 814. 

Rupture of Gravid Uterus, 417, 447. 

Rupture of Uterus, Prolapse of Intes- 
tine through, 821. 

Rupture of Vagina, 814. 

Rupture of Vagina during Coition, 56. 

Rupture of Vagina. Prolapse of Intes- 
tine through, 821. 

Sacro-Sciatic Ligaments, Rupture of, 
821. 

Sacrum, The, 3. 

Saws, Obstetric, 605. 

Scalpels, Obstetric, 600. 

Schistocephalus Bifidus, 297. 

Schistocormus Reflexus, 744. 

Scours, White, 1022. 

Scrotal Hernia, 1059. 

Section, Instruments for, 599. 

Sectors, Obstetric, 605. 

Segmentation of the Egg, 281. 

Senile Atrophy of the Ovaries, 245. 

Septicaemia, Calf, 1033. 

Septicaemia, Puerperal, 905. 

Septic Pleuro-Pneumonia of Calves, 
1032. 

Shears, Obstetric, 604. 

Sheep, Infectious Abortion of, 507. 

Sheep Infectious Agalactia in, 977. 

Sheep, Milk Disease of, 937. 

Sheep, Parturient Paresis in, 937. 

Sheep, Venereal Disease of, 108. 

Sheep, Venereal Disease of in Amer- 
ica, 1 1 14. 

Sinus Venosus, The, 319. 

Somites, 341. 

Sow, Duration of Pregnancy in, 398. 

Sow, Infectious Abortion of, 507. 

Sow, Nymphomania in, 244. 

Sow, Puerperal Eclampsia in the, 920. 

Spasm of Cervix Uteri, 682. 

Spatulas, Obstetric, 608. 

Special Sense, Development of the 
Organs of, 296. 



Index 



ii?5 



Specific Infections of Coition, 73. 

Spinal Cord, The, 294. 

Spontaneous Degeneration of the 
Testicles, Sterility from, 135. 

Sporadic Abortion, 467. 

Sporadic Dysentery, 1022. 

Sterility, 119. 

Sterility, Castration in, 218. 

Sterility due to Age of Male, 150. 

Sterility due to Anorchidy, 125. 

Sterility- due to "Broken Penis," 147. 

Sterility due to Chronic Metritis, 222. 

Sterility due to Congenital Defects of 
the Ovaries, 155. 

Sterility due to Congenital Tumors of 
the Testicles, 125. 

Sterility due to Cryptorchidy, 125. 

Sterility due to Cystic and Cysto- 
Fibrous Degeneration of the Ova- 
ries, 161. 

Sterility due to Defects and Diseases 
of the Ovaries, 155. 

Sterility due to Defects of the Ovi- 
ducts, Uterus, Vagina and Vulva, 
247-. 

Sterility due to Diseases of the Testi- 
cles and Scrotum, 129. 

Sterility Due to Edema of Ovaries, 
160. 

Sterility due to Inflammation of Ova- 
ries, 158. 

Sterility due to Occlusion of the Os 
Uteri, 252. 

Sterility due to Oophoritis, 158. 

Sterility due to Tumors of the Testi- 
cles, 129. 

Sterility due to Tumors or Hernise of 
Sheath, 145. 

Sterility, Examination of the Male 
for, 151 

Sterilit}' from Adhesions of Penis and 
Prepuce, 148. 

Sterility- from Arrested Development 
of the Penis, 144. 

Sterility from Calcareous Degenera- 
tion of Ovaries, 158. 

Sterility from Debilitating Diseases 
and Overwork, 137. 

Sterility from Defective Secretions of 
the Accessory Genital Glands, 144. 

Sterility from iSxcessive Erection of ; 
the Penis, 146. 

Sterility from Excessive Sexual Use, 

142. 
Sterility, Granular Venereal Disease 

as Cause of, 1099. 
Sterility from Hydrocele, 136. 
Sterility from Idleness and Overfeed- 
ing. 138- 
Sterility from Infectious Diseases, 151. | 



Sterility from Inflammation of the 
Penis, 147. 

Sterility from Lumbar or General 
Paralysis, 149. 

Sterility from Masturbation, 143. 

Sterility from Nymphomania, 161. 

Sterility from Onanism, 143. 

Sterility from Orchitis and Epididy- 
mitis, 130. 

Sterility from Over-Size of Male, 150. 

Sterility from Painful diseases of the 
Feet and Limbs, 150. 

Sterility from Paraphymosis, 149. 

Sterility from Paralysis of Penis, 145. 

Sterility from Phymosis, 148. 

Sterility from Physical Inability to 
Copulate, 144. 

Sterility from Spontaneous Degenera- 
tion of Testicles, 135. 

Sterility from Systemic Disease, 137. 

Sterility from Torsion of the Testi- 
cles, 137. 

Sterility from Tuberculosis of the 
Ovaries, 158. 

Sterility from Tumors of the Ovaries, 

Sterility from Tumors of Penis or 

Prepuce, 145. 
Sterility, Nostrums and Panaceas, for 

273; 

Sterility of Freemartins, 156. 
Sterility of Hermaphrodites, 127,157. 
Sterility of Hybrids, 127, 157. 
Sterility of the Female, 151. 
Sterility of the Male, 121. 
Sterilit}', Prognosis of, 201. 
Sterility, Pyometra in, 222. 
Sterility, Therapeutics of, 203. 
Still Birth, 466. 
Stomatodeal Pit, 304. 
Straining, Control of, 619. 
Strangulated Inguinal Hernia due to 

Coition, 62. 
Stricture of Teats. 993. 
Superfecundation, 413. 
Superfetatiou, 413. 
Supernumerary Teats, 986. 
Swine, Infectious Abortion of, 507. 
Swine, Mammitis in, 978. 
Swine, Venereal Diseases of, no. 
Symptoms of Parturition, 517. 
Syphilis, Equine, 73. 
Systemic Disease, Sterility from, 137. 
Teats, Atresia of, 993. 
Teats, Stricture of, 993. 
Teats, Supernumerary, 986. 
Teats, Warts on the, 992. 
Teats, Wounds of the, 991. 



II26 



hidex 



Teeth, Aberrations in the Develop- 
ment of, 313. 
Teeth, The, 311. 
Teeth, Tumors of, 1069. 
Teratology, 367. 
Testicles, Sterility from Spontaneous 

Degeneration of, 135. 
Testicles, Sterilit}- from Torsion of 

the, 137. 
Testicles, Dermoid Cysts of the, 125. 
Testicles, Sterility due to Tumors of, 

129. 
Testicle, The Embryology of, 335. 
Tetanus Neonatorum, 102 1. 
Tetanus, Puerperal, 909. 
Tetanus, of the New-Born, 1021. 
Therapy of Sterility, 203. 
Tongue-tie, io6g. 
Torsion of the Uterus, 693. 
Torsion of the Testicles, Sterility 

from, 137. 
Traction, Direction of Application to 

the Fetus 5S6. 
Traction on Fetus, Amount of, 58S. 
Traction on Fetus, Development of 

Force in, 591. 
Transverse Development of the Fetus, 

Dystokia from, 716. 
Transverse Presentations, 786. 
Transverse Presentation, Dorsal, 786. 
Transverse Presentation, Ventral, 788. 
True Corpus Luteum, 16. 
Tubal Pregnane}', 416, 
Tubercular Mammitis, 970. 
Tuberculosis of Ovaries, Sterility 

from, 158. 
Tuberculosis of Udder, 970. 
Tumors, Congenital, of Testicles, 125, 
Tumors of the Fetus, 741. 
Tumors of Genital Passages, 690. 
Tumors of the Mammte, 981. 
Tumors of Ovaries, as Cause of vSte- 

rility, 159. 
Tumors of Penis or Prepuce, Steril- 
ity from, 145. 
Tumors of the Testicles, Sterility 

from, 129. 
Tunica Albuginea, 15, 44. 
Tunica Granulosa, 46. 
Twins, Dystokia of, 752. 
Twin Pregnancy, 399. 

Udder, Actinomycosis of, 972. 
Udder, Botryomycosis of, 974. 
Udder, Dermatitis of the, 988. 
Udder, Edema of, 979. 
Udder, Exanthema of, 968. 
Udder, Furunculosis of the, 990. 
Udder, Pendulous, 988. 



Udder, The, 35. 

Udder, Tuberculosis of, 970. 

Udder, Wounds of the, 991. 

Umbilic Cord, Care of, 558. 

Umbilic Cord,, Rupture of, 558. 

Umbilic Cord, The, 364. 

ITmbilic Hemorrhage, 1037. 

Umbilic Hernia, 1046. 

Urachus, Open, 1039. 

Urachus, Persistent, 1039. 

Ureters, 334. 

Urino-Genital System, Development 

of, 332. 
Uterine Abscess, 896. 
Uterine Cavity, Dropsy of the, 430. 
Uterine Milk, 25. 
Uterine Prolapse, S23. 
Uterus, Actinomycosis of the Broad 

Ligaments of the, 113. 
Uterus, Amputation of, 844. 
Uterus, Deviation of the, 692. 
Uterus, Dropsy of the, 430. 
Uterus, Dystokia from Displacements 

of, 692. 
Uterus, Eversion of, S23. 
Uterus, Form of the Pregnant, 374. 
Uterus, Hemorrhage from the Gravid, 

457- 
Uterus, Hernia of, 445, 692. 
Uterus, Inversion of, 823. 
Uterus, Involution of the, 527. 
Uterus, Prolapse of, 823. 
Uterus, Prolapse of Vaginal Portion 

of, 201, 449. 
Uterus, Prolapse of Intestine through, 

821. 
Uterus, Position of the F'etus in, 379. 
Uterus, Rupture of the Gravid, 447. 
Uterus, Sterility Due to Diseases of 

247. 
Uterus, The, 24. 
Uterus, The Round Ligament of the, 

26. 
Uterus, Torsion of the, 693. 
Uterus, Rupture of, S14. 
Uterus, Rupture of Gravid, 417. 

Vagina, Ante-Partum Prolapse of, 

449- 
Vagina, Eversion of, 848. 
Vagina, Lacerations of the. During 

Coition, 56. 
Vagina, Prolapse of Bladder through, 

822. 
Vagina, Prolapse of Intestine through, 

821. 
Vagina, Prolapse of the, in Sterility, 

199. 
Vagina, Rupture of, 819. . 



->-, 



Index 



1127 



Vagina, sterility Due to Diseases of, 

247 
. .gitia, The, 31. 

Vaginal Catarrh, Infectious, of Cat- 
tle, 97, 1075. 

Vaginal Hysterotomy, 6S7. 

Vaginal Portion of the Uterus, Pro- 
lapse of, 449. 

Vaginal Prolapse, S4S. 

Vaginitis, 89S. 

Vaginitis, Infectious Granular of 
Cows, 1075. 

Vaginitis Verrucosa of Cows, 97, 
1075. 

Veins, The, 326. 

Venereal Disease, Apthous, 95. 

Venereal Disease, Eruptive, of the 
Horse, 92. 

Venereal Disease, Granular, of Cattle, 
97, 1075. 

Venereal Disease of the Dog, 104. 

Venereal Disease of Rabbits, no. 

Venereal Disease of Sheep, 108. 

Venereal Diseases of Sheep in Amer- 
ica, 1 1 14. 

Venereal Disease of Swine and Goats, 
no. 

Venereal Diseases, 73. 

Veneral Diseases of Cattle, 95. 

Venereal Granulomata of the Dog, 
104. 



Ventral Transverse Presentation, 788. 

Version of the Fetus, 634. 

Vesicle, Blastodermic, 2S4. 

Vesico-Vaginal Fistula, 863. 

Vesicular Exanthem, 95. 

Vitelline Membrane, 46. 

Vitelline Sac, The, 347. 

Volume of the Fetus, Excess of, 727. 

Vulva, Hematoma of, 864. 

Vulva, Imperforate, 1064. 

Vulva, Sterility Due to Disease of, 

247. 
Vulva, The, 33. 
Vulvitis, 898. 

Wandering of Genital Cells, 414. 

"Water Bag ", Rupture of, 54S. 

Warts on Teats, 992. 

White Scours, 1022. 

Wild Animals, Duration of Pregnancy 

in, 39S. 
Wolffian Bodies, The, 332. 
Wolffian Ducts, The, 332. 
Wounds and Injuries to the Genital 

Organs, 812. 
Wounds of the Udder and Teats, 991. 
Wry-Neck, 746. 

Yolk Sac, The, 347. 

Zona Radiata, 46. 



